SCI (Canada) Ltd. Affinity Program

Your New Voluntary Benefit Plan

ONE: Select your Affinity Benefits Group from the drop down list below. If your group does not appear on the list, simply select "Other" from the drop down list and then type your group name in the "Other" field.

Affinity Benefits Group*
   
Other  

TWO: Complete the simple "Registration Form" to the right. Please note that all fields marked with an asterisk (*) must be filled in for successful submission.

THREE: When the form is completed, simply print this page using the "Print Page" button below and fax it directly to 604-985-8822, or mail it to Affinity Registrar, 1505 Lilloet Rd., North Vancouver, B.C. V7J 2J1.

 
Registration Form
   
Name* 
 
Address 
 
Phone* 

E.g., home, work or cell. For member confirmation only!
 
Fax 
 
Email 

Click here to return to AffinityMembership.ca Web site.

This page was printed from http://www.AffinityMembership.ca/registration-form.htm.