Membership Verification

Please use the form below to complete your registration for the Detroit Regional Chamber Affiliate Participation Program.
Once you have completed this form, you will receive an automatic email with your Registration Verification.
Please print the Registration Verification as proof of membership for your BCBSM paperwork.

The Registration Verification form will be emailed to the address listed in the email field below.
For questions or more information, please contact the Insurance Service Center at (877) 227-1500.

Affiliate Participant Registration
Company :
First Name :
Last Name :
Title :
Email :
Phone :
Website :
Industry :
No of Employees :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Membership Affiliations :
Franchisee :
Multiple Locations :
HR/Benefits Contact :
HR/Benefits Contact Email :
Office Supply Contact :
Office Supply Contact Email :
Networking/Events Contact :
Networking/Events Contact Email :