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WELLCALM Join & Book - Corporate
1
JOIN WELLCALM AS A MEMBER
First Name
Last Name
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2
What's your email address?
example@example.com
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3
What's your Mobile Number
*
This field is required.
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4
Please select your Insurance Provider
Sun Life Financial
Manulife
Canada Life
Great West Life
SSQ Financial Group
Green Shield Canada
Medavie Blue Cross
Pacific Blue Cross
Industrial Alliance Insurance
La Capitale assurances et gestion du patrimoine
Empire Life Insurance Co
Equitable Life Insurance Co. of Canada
The Co-operators Life Insurance Co.
RBC Insurance
Assumption Life
GMS Insurance Inc
League
Johnson Inc.
Johnston Group Inc
Manulife Financial
Maximum Benefit
GroupSource
GroupHEALTH
CINUP
Chambers of Commerce Group Insurance
Cowan
Desjardins Insurance
First Canadian
Other / Not Shown
Sun Life Financial
Manulife
Canada Life
Great West Life
SSQ Financial Group
Green Shield Canada
Medavie Blue Cross
Pacific Blue Cross
Industrial Alliance Insurance
La Capitale assurances et gestion du patrimoine
Empire Life Insurance Co
Equitable Life Insurance Co. of Canada
The Co-operators Life Insurance Co.
RBC Insurance
Assumption Life
GMS Insurance Inc
League
Johnson Inc.
Johnston Group Inc
Manulife Financial
Maximum Benefit
GroupSource
GroupHEALTH
CINUP
Chambers of Commerce Group Insurance
Cowan
Desjardins Insurance
First Canadian
Other / Not Shown
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5
Policy Plan #
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6
Member ID Number
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7
Date of Birth
-
Month
Day
Year
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8
Address
*
This field is required.
Street Address
Suite #
City
Province
Postal
Country
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9
Membership
Join as a Member or as a Monthly Member and receive and receive a 60 minute massage, massage table and massage sheets.
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( X )
WellCalm Member
We will bill your Insurance Directly and Charge you the difference for your treatments.
$
Free
CAD
for each
month
JOIN
WellCalm Monthly Membership
1 x 60 Minute Massage a month, 1 x Massage Table 1 x Set of Massage Sheets $149 plus HST for the First Month, $119 plus HST for each month after
$
168.37
CAD
for the
first month
then,
$
134.47
CAD
for each
month
JOIN
Credit Card
First Name
Last Name
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