OEBB Fitness Rewards Registration Form - oregon 2025

1. Click ‘Get Form’ to open the OEBB Fitness Rewards Registration Form in the editor.
2. Begin with the Health Assessment section. Ensure you have completed your individual Health Assessment with your medical plan carrier, as this is a prerequisite for program eligibility.
3. Fill in your Member Information accurately. Include your last name, first name, date of birth, contact address, and phone number. If you have a new address, check the corresponding box.
4. In the Fitness Facility Information section, provide details about your fitness facility including its name and address. Indicate your membership type and amount paid.
5. Complete the Direct Deposit via ACH Authorization by filling in your account information. Attach a voided check if using a checking account.
6. Sign and date the Member Attestation to confirm that all information is accurate and complete.
7. Finally, submit the form along with any supporting documents either by mail or fax as indicated at the bottom of the form.

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