Registration

Register online by completing the form below.

Register over the phone by calling us at
1-844-832-9102
or 905-387-7125.

Person on laptop
Person on laptop

Registration Form

Fields marked with * are required

Member Information

Full name *

Date of birth *

Address

Contact



USW 1005 Member Information

Additional Medicine Coverage


Physician Information

By providing us with your physician's information, we are able to send details to your doctor's office.

Physician address

Additional Information


Don't forget step 2

Complete your transfer

Begin Transfer