MEMBERSHIP CARD

APPLY FOR YOUR MEMBERSHIP CARD ONLINE!

Please fill in all details. Your medical information will be kept secret and confidential, and will be printed on the back of your membership card in the form of a QR Code. This code can be scanned by emergency personnel in the event of you being unable to talk and inform them of any special conditions or allergies.

Be sure your spelling is correct, as the information will be printed as is.

MEMBERSHIP CARD







Add your full names only EXCLUDING your surname

Add your syrname

Add the name people usually address you on. This is usually only one of your names or shortened form of your name. This name together with your surname will appear on your membership card


Your staff or personell number. Leave blank if not known



This information will be stored in a secure emergency QR Code

This information will be stored in a secure emergency QR Code

Name of person to contact in the event of an emergency

Mobile or other number to contact in the event of an emergency


Please state your allergies here.

This information is to assist paramedics or doctors to administer the correct treatment should you be unable to speak for yourself.