The form below is used to sign up for Delta Premiere & Delta Care. It must be obtained from your local office representative. If he or she is not available contact Danette Mitchell by personal e-mail dmitchell1222@gmail.com or phone (313) 333-4597.
Please indicate which program you are enrolling in by using the following Group Code:
2116-0004 - Delta Premiere 8116-0004 - Delta Care EPO