Join now Complete the quick join form here. PERSONAL INFORMATIONTitle*Initials*Name* First Last ID number*Marriage status*Language*Sex*Highest qualification*Occupation*Postal address*Postal code*Physical addresss*Code*Tel home*Cellphone number*Tel workFax numberEmail address* COMMUNICATIONELECTRONIC NEWSLETTER*ELECTRONIC NEWSLETTERAFRIKAANSENGLISHNONEMEMBER BENEFITS*MEMBER BENEFITS SMS EMAIL CALL GENERAL*GENERAL SMS EMAIL CALL DEBIT ORDER CONFIRMATION (please mark the appropriate fields)Account holder*Bank name*Type of account*Account number*Branch code*Trust / Company / CC / Personal*Day of debit order*Day of debit order1st16th25thFirst month from which debit order will commence*Amount*R350 P.M.R250 P.M.R150 P.M.R100 P.M.R1200 ANNUALLYDifferent amountOther amount per month R100 P.M. (MIN.)Other amount per year R1200 ANNUAL (MIN.)Authorisation to bank: I/we hereby request and authorise you or your authorised agent to draw against my/our account with the abovementioned bank (or any bank/branch to which I/we may transfer my/our account) the amount necessary for the monthly premium due in respect of the above mentioned membership. All such withdrawals from my/our bank account shall be treated by you as though they have been signed by me/us personally. I/we agree to pay the bank charges in connection with these instructions and the costs thereof in accordance with the South African clearing bank’s tariff in force at the time. I/we understand that: The withdrawals hereby authorised will be processed by computer; Details of each withdrawal will be reflected on my/our bank statement or the accompanying voucher; and The obligation to ensure that you receive my/our monthly premiums remains with me/us, despite this debit order authorisation which is granted to you. I/we undertake to satisfy myself/ourselves from time to time that the amount necessary for payment of the monthly premium due in respect of the abovementioned membership is duly drawn by you in terms of this debit order authorisation, and I/we hereby record that your acceptance of this debit order authorisation in no way places any onus on you to ensure that the monthly withdrawals of the amount refereed to herein are made. This authorisation shall be in full force and effect until it is cancelled by me/us by giving 30 days’ written notice by registered post, but I/we understand that I/we shall not be entitled to any refund of any amount which you have withdrawn while this authority was in force, unless I/we can prove that any such amounts were not legally owing to you. Receipt of this notice by you shall be regarded as receipt of the notice by my/our bank. Completed and signed at*Signature*Date* Date Format: DD slash MM slash YYYY CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.