UPDATE YOUR DETAILS

There is space update your contact details as well as add the details of up to 5 female dependants below. Should you have additional female dependants, you can either fill in their details in the message box provided, or email us at bonitasfemalehealth@careworks.co.za

Thank you!

MAIN MEMBER

Name *

Email *

Membership number *

COMMUNICATION PREFERENCE

Opt in / out *

Subscribe my female dependants to the Female Health newsletters AS WELL AS me Subscribe my female dependants to the Female Health newsletters INSTEAD OF me

DEPENDANTS

NOTE: The dependant's code is found on your membership card. The main member's code is always 00 - each dependant will have their own code, e.g. 01, 02, 03, etc.

1. Name

Dependant code

2. Name

Dependant code

3. Name

Dependant code

4. Name

Dependant code

5. Name

Dependant code

Please enter any additional dependants' details here: