Family or group - Invoice request

If you will be participating in the Earth Heal event with other members of your family, pets or friends, please answer the questions below to help us work out and send the invoice to you.

Q1 - Q6 require an answer, Q7 - Q9 are optional.
 
Send the completed form by clicking the 'Done' button at the bottom of the page when you have finished, or if you prefer to send it via e-mail, just copy and paste the completed form (without clicking the "Done" button) into the body of an e-mail and send it to earthhealadmin[at]gmail[dot]com

We will be in touch with you via e-mail as soon as possible.

* 1. Name

* 2. E-mail address

* 3. Which country do you live in?

* 4. Total number of participants in your group to be included in this event (including yourself):

* 5. Please let us know how many adults, seniors, children and animals are in your group:

  One Two Three Four Five
Adults - $10 USD (roughly 134 ZAR)
Seniors (over 65) - $8 USD (roughly 107 ZAR)
Children (under 18) - $8 USD (roughly 107 ZAR)
Animals (pets) - $5 USD (roughly 67 ZAR)

* 6. Would you like us to send you an invoice with a link to make your payment from PayFast, our preferred payment gateway?

* 7. If no to Q6,  would you like an invoice sent to you from Payoneer? (Our second choice)

* 8. If no to Q7, would you like us to send you a PayPal invoice?

* 9. If no to Q8, please indicate below which payment method you would like to use.  Where applicable, additional amounts in USD  are added in brackets, .to cover commission, bank charges or other costs.

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