Employee Benefits Waiver Form 2019 Please enable JavaScript in your browser to complete this form.Employee Name *FirstLastDate of Employment *I hereby waive the right to the following benefits provided by Lunar Massage: *MedicalDentalVisionPrescriptionSignature: The advantages of the benefits have been explained to me, and I willingly decline enrollment. *Clear SignaturePrint Name: *Date / Time *WebsiteSubmit
