*
=
Required field
CARD NUMBER
*
Enter the
first 11 digits
of the Bar Code on the back of the card (no spaces).
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
Province
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Saskatchewan
Yukon
Postal Code
*
Age
*
18-24
25-34
35-44
45-54
55-64
65+
Gender
Male
Female
Which pharmacy do you normally visit?
I want to be informed of upcoming offers from The Rexall™ family of pharmacies
*
Yes
No
E-mail Address
*
Confirm E-mail Address
*
We keep your personal information confidential.
See our
Privacy Policy
for details.
©2008 Katz Group Canada Ltd. Rexall is a registered trademark of Rexall Brands Corp., a member of the Katz Group of Companies.
All rights reserved. Visit us at
Rexall.ca
.