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Primary Member Details

First Name Last Name Date of Birth BID number Your Health Authority Please Select...I do not work at a Health AuthorityFHA - Fraser Health AuthorityIHA - Interior Health AuthorityNHA - Northern Health AuthorityVIHA - Vancouver Island Health AuthorityVCHA - Vancouver Coastal Health Authority

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Check this box if you are a dependent on the benefits plan, i.e. spouse or child

Please enter your personal mobile number and email. They will be used by the ALAViDA Care Team to reach out to you and for notifications on your TRAiL app. Email Mobile Number Preferred Language EnglishFrench Province Please Select...AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon