Family or group - Invoice request

If you are registering an annual membership for a family or group i.e. more than one, please answer the questions below to help us work out and send the invoice to you.

Q1 - Q6 require an answer, Q7 - Q10 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 humans and animals in your group, including yourself:

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

  One Two Three Four Five
Adults - $36 USD (roughly 480 ZAR)
Seniors (over 65) - $29 USD (roughly 387 ZAR)
Children (under 18) - $22 USD (roughly 294 ZAR)
Animals (pets) - $15 USD (roughly 200 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 you have any other queries regarding payment for group or family annual membership, please write them in the box below.

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

* 10. If no to Q8, please indicate below an alternative payment method you are able to use.  Where applicable, an additional amounts in US dollars is added in brackets, to cover bank charges, commission or other related costs.

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