Sign Up

Complete, print, and mail the form below to CAPS along with the appropriate membership dues. Make checks payable to CAPS, then print and mail them to the address to the right.

Personal Information

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone Number*

DOB (mm/dd/yy)*

Family Information

Spouse

DOB (Spouse)

Child 1

DOB (Child 1)

Child 2

DOB (Child 2)

Child 3

DOB (Child 3)

Yearly Membership Dues

Select the plan you are interested in.*

Individual ($53.00)

Individual + 1 ($73.00)

Family ($93.00)

Payment

Please select your preferred method of payment.
Note: No credit card information will be stored.

Credit Card Number

Expiration Date

CCV Number

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Contact

Rates

Individual ($53.00)
Individual + 1 ($73.00)
Family ($93.00)

Fee Schedule

Members save 20% to 40% off the average dental fees charged in the Twin Cities.

MN Dental Insurance | CAPS Fee Structure

Benefits

Quality Dentistry
Low Cost
Access to Specialty Care
Convenience
Stable Membership Fees

Minnesota Dental Plans from CAPS Dental Plan

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Rates

Fee Schedule

Benefits

Fee Schedule #38

Testimonials