System Generated Field Panel
Author Entered Field Panel
Author Input Panel - Required fields
Form Title Panel
End-user Entered Field Panel
If you are requesting a fair for more than one location please submit a separate request form. If you are requesting a multiple day event, please provide additional date and time detail in "Dates/Times for Additional Benefit Fair Days" text area.
* Required Fields
Agency Information
Benefit Fair Information
* Benefit Fair Date
* Benefit Fair Start Time
* Benefit Fair End Time
Dates/Times for Additional Benefit Fair Days
Shipping Address
MetLife will ship materials to this event. You do not need to order them.
Special Requests
Submission of this request does not guarantee representation at your agency's benefit fair. If you have any questions, please email federaldental07@metlife.com.
MetLife respects your Privacy
Thank You/Error Panel Configuration
Option One/Two Configuration
Error
An error has occurred. Please try again later.
Go back to homepage.
Thank you
Your request has been submitted.
Go back to homepage or submit another request.
Option Three Configuration
Hidden Panel