MEMBERSHIP

Membership is what makes the emblem work

An emblem identifies you. Membership keeps your medical record current and accessible to responders 24/7. Together, they protect you.

Apply for Membership

WHAT MEMBERSHIP INCLUDES

✓

The option to purchase the engraved MedicAlert emblem

Your chosen bracelet or necklace, engraved and ready to wear.

✓

Your secure 24-hour record

Conditions, medications, allergies and contacts, accessible day and night.

✓

The emergency response line

A single number connecting responders to your record.

✓

Annual membership & updates

Keep your record current as your health changes.

Membership Application

Complete this medic alert registration form to apply for membership and complete your debit order details for the monthly fee of R57.

1 Contact details
2 Personal information
3 Physical address
4 Postal address
5 Medical details
6 Doctor's address
7 Medical aid
8 Next of kin
9 General
10 Debit order details

Contact details

Title

First name

Last name

Phone

Personal information

Occupation

ID Number 13 digits

Gender

Physical address

Street Address

Suburb

City

Province

Post Code

Country

Postal address

Street Address

Suburb

City

Province

Post Code

Country

Medical details

Medical Condition

Bracelet Engraving Please be aware that emblems have varying engraving spaces.

Doctor's Title

Doctor's First Name

Doctor's Last Name

Doctor's Phone

Doctor's address

Street Address

Suburb

City

Province

Post Code

Country

Medical aid

Medical Aid Provider

Medical Aid Number

Hospital Plan Name

Hospital Plan Number

Preferred Hospital

Next of kin

Next of Kin's Title

Next of Kin's First Name

Next of Kin's Last Name

Relationship

Next of Kin's Phone Number Including area code, e.g. (012) 345 6789

General

Where did you hear about MedicAlert?

Would you like to receive SMS updates?

Would you like to receive our Monthly Newsletter?

Debit order details

Bank Name

Branch Name

6 Digit Branch Code

Type of Account

Account Number

Debit Order DateDay of the month to process the debit order.

I hereby authorise Medic Alert to debit my bank account as set out above. I understand and accept that my specified bank account be debited with the specified amount on the specified day each month. I understand and accept that this authorisation will continue until we receive written notification to discontinue. I undertake to keep Medic Alert informed regarding changes to my account at all times.

Membership fee

A simple monthly membership, billed by debit order. Your emblem product is purchased separately in the shop.

Monthly membership

R57/ month

Payable via debit order - the emblem is purchased separately

✓The option to purchase a personalised, engraved MedicAlert emblem

✓24-hour Emergency Contact Centre in 11 official languages

✓Your next of kin notified in an emergency

✓Wallet card with your emergency contact numbers

✓Free MedXpert™ medical scheme advice & support

Apply for membership

THE JOURNEY

From decision to protected, step by step

Learn why emergency ID matters

Complete the membership application

Add your chosen emblem product

Pay securely via Payfast

Receive confirmation & next steps