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Get Canada AHC0201 - Alberta 2009

our ofice or visit our website. Telephone 780-427-1432 Edmonton Toll-free within Alberta at 310-0000, then 780-427-1432 Fax 780-422-0102 Website www.health.alberta.ca Please read the information on the back of this form before applying for Alberta Blue Cross Non-Group coverage. Your application can only be accepted if you have Alberta Health Care Insurance Plan coverage and your account is paid in full. Personal health number Account holder's personal information (Please print) — Title.

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