Membership Application Form

DEADLINE FOR APPLICATIONS IS Friday, September 15, 2017
(A late fee of $50.00 will be charged on ALL late applications and a $30.00 charge for NSF cheques.)















Membership Fee
Late Fee (apply after September 15, 2017) $ 50.00
University of Manitoba Library Fund $ 10.00
WDS Scholarship $ 20.00
 
Blue Cross Coverage
Note: If you do not currently have Blue Cross coverage but wish to join phone (204) 988-5300 to request a Blue Cross application form.
New Member Yes   No

Please Choose a Plan
No Plan -  
Plan I
Covers Ambulance, Semi-private Room, Medical Hostel accommodation
Single $19.20  
Couple $38.40  
Family $38.40  
Plan II
Includes the benefits of Plan I plus prescription drugs, private duty nursing, cardiac rehabilitation, dental treatment for accidental injury, prosthetic appliances, medical equipment, physiotherapy, chiropody, nutritional counselling, clinical psychology, athletic therapy, vision, massage therapy, and chiropractic.
Single $946.80  
Couple $2,055.60  
Family $2,055.60  
Total
  
Note: A dentist must be licensed and a member of the Winnipeg Dental Society in order to be eligible for Blue Cross coverage. Once you are registered for benefits under Plan II you cannot change your coverage back to Plan I. New Blue Cross subscribers become eligible for plan benefits on January 1, 2018.