| East Central Illinois Pipe Trades Health & Welfare Fund Enrollment Checklist |
1.) Complete and sign the Enrollment Form, making sure you indicate your plan choice and
whether you also
want coverage for your spouse.
2.) If you wish to use the automatic checking or savings withdrawal option, please complete and
sign the Authorization Agreement For Direct Payments
3.) If you wish to pay by invoice each month, please make check payable for the first month's
premium to NPRIT/PipeTrades
4.) Please return all materials to:
PipeTrades
c/o NEBCO
144 Metro Center Blvd. Suite 1
Warwick, RI 02886
Attention: Customer Care Center