Member Email Submission
We'd love to connect with you in more meaningful ways.
Are you an Owner or an Insured on a Gleaner Life certificate?
Owner
Insured
Name of the Insured
*
First Name
Last Name
Insured's Email
*
example@example.com - if the insured is under the age of 18, please indicate a parent/guardian email.
Name of the Owner
*
First Name
Last Name
Owner's Email
*
example@example.com
Certificate Number:
*
Please include insured certificate number. A certificate number follows this format 010XXXXXX
If this insured has multiple certificates, add the email(s) to all certificates?
*
Yes
No
If you are unable to locate your certificate number(s), please call 800.992.1894 and ask to speak with Member Services to obtain this information.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
In case we are unable to locate your information on our system, we will call and work with you over the phone.
Format: (000) 000-0000.
By providing your initials to this form, you confirm that you are the certificate owner (or an authorized representative) and have the authority to add the email address provided to the record associated with the certificate number(s) listed. You authorize Gleaner Life Insurance Society to use this email address for official communications, which may include—but are not limited to—information regarding Arbor events, member benefits, Society programs, scholarships, and other member-related updates
*
Submit
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