VIA Préférence - Join Today!

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	Préférence, Privilège & Premier Membership
	Travel Rewards

Welcome to VIA Préférence

Please complete and submit the enrollment form below.
The information you provide will enable us to send you your permanent membership card.

Don't forget! Be sure to always quote your VIA Préférence membership number every time you book travel on VIA Rail or use our Partners. Earning your rewards is easy and you don't want to miss any opportunities.

Note: The fields with an asterisk (*) are mandatory.

LOGIN INFORMATION:
Email Address:
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Note: By providing your e-mail address, you will benefit from special offers and discounts exclusive to VIA Preference members.
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Miss Ms. Mrs. Mr. Dr.
*First Name:	Middle Initials:
*Last Name:
Date of Birth:
*Language Preference:	English French
*Preferred Mailing Address:	Permanent Business
Note: Only your preferred address fields are mandatory.

PERMANENT ADDRESS:
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Floor/Suite/P.O. Box/Apt.:
*City:
*Country:	Canada	United States
*Province/State:
*Postal Code / Zip Code:	-	(i.e. 55523)

BUSINESS ADDRESS:
*Street:
Floor/Suite/P.O. Box/Apt.:
*City:
*Country:	Canada	United States
*Province/State:
*Postal Code / Zip Code:	-	(i.e. 55523)

OTHER INFORMATION:
Gender:	Female Male
I travel mostly for:	Business Family-Leisure School
Home Telephone:	( )
Business Telephone:	( ) Ext:
Mobile phone:	( )
Business Fax:	( )
Company Name:
Title:
Household Income:	$0-$25,000 $25,001-$50,000 $50,001-$75,000 $75,000 +
How did you hear about the program ?	VIA Travel Agent Colleague Other:

DECLARATION / CONFIDENTIALITY Your privacy is important to us. Please be assured that at no time will your personal information be sold or rented to a third party. Be advised that by enrolling in the VIA Préférence Reward Program you agree to receive a membership kit and regular communications. In addition, VIA Préférence partners may use your personal data to develop separate promotions and offers.
If you prefer not to receive separate partner communications, please check this box.