Printers’ Disability Trust

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Printers’ Disability Trust

Before filling please read below instructions carefully.

Your employer must be an existing member of PDT. Coverage must be for a group of 2 or more. New members should contact PDT directly to obtain coverage.
  1. Download the Form: Use the download button to access the form.
  2. Complete the Form: Fill in the required information directly within the PDF.
  3. Upload the Completed Form: After completing the form, download the filled file and upload it in the “upload filled file” section below.
  4. Submit Your Information: Provide your name and email address, then upload all files to complete the submission.

    Employer Name *
    Employer Email *
    Employer Representative *
    Employee Name *
    Effective Date of Coverage * Message Upload Filled File *
    Enrollment Form DentalVision 1 2 page 0001
    Download File

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