Membership Application

Membership Application

Thank you for applying for your membership online. The process is simple and wont take long. Start by filling out the form below. When you’ve finished click the button to apply and pay .
Firstly tell us which Friends you would like to join.
I also have friends or family in (tick all that apply)

Australia South Africa New Zealand USA / Canada
Title
Full Name *
Address *
Please include the postcode
E-mail *
Home Phone / Mobile *
Work Phone (if applicabale)
Date of Birth (dd/mm/yyyy) *
Once you become a member you can nominate a relative or friend living in South Africa, Australia, New Zealand, USA or Canada as your nominated partner on the Free Serious Accident Emergency Travel Benefit. This means that in the event of a Serious Accidental Injury or Accidental Death to either yourself or your nominated ‘Overseas’ we will fly either you to them or vice versa on the first available flight. Subject to the conditions of this benefit.
Title
Full Name
Address
Please include the postcode
Home Phone / Mobile
Work Number (if applicable)
Email Address
Date of Birth (dd/mm/yyyy)
Relationship to Member
Nominate more than one partner

Tick this box if you would like to include more than one nominated partner. (You will be sent the required form)
Please complete the security question *
Should be Empty: