Clone of All-In-One Membership One-Payment Option

All-In-One Membership Registration
Your Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Your E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Date of Accident *

DayMonthYear
Date
Date of Birth

DayMonthYear
Date
WSIB Claim Number*
Membership Payment
Payment Options

Payment by E-transfer

Payment to: payments@wsibsettlements.com

1-Payment - $1130.00 (Save $100)

2-Payments - $565 each

IMPORTANT

Once you have made your payment, click the submit button below to complete your membership registration.
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