| 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.
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.
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