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NEW ENROLLMENT
Welcome to the NewWave and Alaris sponsored Flagship Rewards Program. To get started please fill out this
form and hit submit.
If you do not know your NewWave Account Number please call your NewWave Rep to
obtain that information at (800)536-5222.

There is a 1-2 business day approval time on new accounts. You will be notified via email when your
account has been activated

Note, your SSN will be required if you win prizes totaling $600 or more

* Are Required fields

First Name: *
Last Name: *
Title:
SSN: - -
Phone Number: *
Email Address (user name): *
Create a Password: *
NewWave Account #: *
Company Name: *
Address: *
Suite/Apt:
City *
State: *
Zip: *
 
I understand and agree that I am responsible for all tax liabilities associated with
any and all prizes that I win. A 1099 will be issued for all prizes totaling over
$600 with in a calendar year (including trips)