Online Application Form

New Membership Application Form & Life Benefit

This is a 2 page form; complete both pages. New Membership Fee: 1 yr $133 (Includes Life Benefit of $5000 payable upon death).
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MEMBERSHIP

Title(*)

Select one

First Name(*)

Please enter your First Name and Last Name

Middle Name

Please enter your Middle Name

Surname(*)

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Date of Birth(*)

/ / Invalid Date of Birth

Telephone Home

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Telephone Work

Invalid Input

Telephone Cell

Invalid Input

Barbados ID #(*)

Invalid Input

Address Line 1(*)

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Address Line 2

Invalid Input

Address Line 3

Invalid Input

Address Parish(*)

Select One

Mailing Address

Invalid Input

Mailing Address Line 2

Invalid Input

Mailing Address Line 3

Invalid Input

Mailing Address Parish

Select One

Email Address

Please enter your email address.

Current/Former Occupation(*)

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HEALTH INSURANCE

Do you have Health Insurance? (*)

YesNo Invalid Input

If yes, which company?

Invalid Input

Do you want to purchase the BARP Group Health Insurance Plan?(*)

YesNo Invalid Input

MASSY CARD

Do you have a Massy Card?(*)

YesNo Invalid Input

Massy Card Number #

Invalid Input

Do you want to link your BARP Membership Card with your Massy Card?

YesNo Invalid Input

Please indicate your skills, interests, and area of expertise to update our skills bank. Agriculture, Accounting, Advertising, Automotive, Business, Cosmetology, Education, Engineering, Entertainment, Event Planning, Financial Services, Health Care, Human Resources, Information Technology, Insurance, Legal, Management, Renewable Energy, Telecommunications, Training & Development please specify. TRADE: Carpentry, Labourer, Plumber, Mason, Painter, Electrician if Other, please specify.

Skills

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PART 2 - LIFE BENEFIT ENROLLMENT
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Occupation(*)

Invalid Input

Title:(*)

Invalid Input

First Name(*)

Invalid Input

Middle Name

Invalid Input

Last Name(*)

Invalid Input

Address(*)

Invalid Input

Telephone Mobile

Invalid Input

Telephone Home

Invalid Input

Telephone Work

Invalid Input

Date of Birth(*)

/ / Invalid Input

Coverage(*)

Life Invalid Input

Maiden Name

Invalid Input

BENEFICIARY DESIGNATION

Name of Beneficiary(*)

Invalid Input

Relationship to Member

Invalid Input

Beneficiary Date of Birth(*)

/ / Invalid Input

National Registration/Driver's Licence/Passport No:(*)

Invalid Input

Nationality(*)

Invalid Input

I reserve the right to change the beneficiary designated above, subject to any statutory requirement.

ANTI-SPAM

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Check the box above to let us know a real person is filling out this form.

*Visit the BARP office in 3 business days to make the payment; sign the Life Benefit, and take the photo for your BARP card.

Online Application Form

New Membership Application Form & Life Benefit

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