UMP Registration

1
Thank you for your interest in our Union Membership Program, a program created specifically for Union Members to help them manage their claim with the Workplace Safety & Insurance Board.

Please complete this short form so that we are able to provide your members with the best possible rate.
2
NameYour name
First Name
Last Name
3
Phone Number* This field is required.
Area Code
Phone Number
4
E-mail* This field is required.
example@example.com
5
Union Name* This field is required.
6
Local* This field is required.
(e.g. CWA Local 2101 in Ontario)
7
Number of Members* This field is required.
1-50
1-250
1-500
500+
Should be Empty: