UMP Contract & Wait List Form
UMP Employees ONLY.
UMP employees must submit this form to be added to a wait list or to cancel a contract.

This form is NOT for University or Fairview employees.
University employees should use the UMN Wait List & Contract Form to manage their wait lists and to purchase contracts. Fairview employees should email parking@umn.edu.

PTS bills UMP for contracts, UMP then bills their employees at a discounted rate.
For rates and billing information, contact UMP benefits staff.
PTS cannot provide UMP rates or billing information.

UMP email required: @umphysicians.umn.edu
If a personal, @umn, or @fairview address is used, your form submission will not be accepted.

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Email *
UMP Employee ID number (4-6 digits) *
First Name *
Last Name *
Campus Mail Code & Dept.
Provide your campus mail code and dept., not the physical address.
Example: 2121AA Pharmacy
 *
I want to: *
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