Co-Members included

MONTHLY MEMBERSHIP FEES

Household Membership : R310 per household p/m. By submitting this form you are applying for CMR Membership which includes the cost of the CMR’s rapid advanced life-support paramedic response service and any treatment and medical consumables used in treatment.

Do you want CMR Ambulance Transport Cover at R130 per household p/m? If you select not to take this cover the cost of the ambulance transport is not included.

Please note fees increase on the 1st of April 2022 for all members.

IF MORE THAN 6 PEOPLE NEED COVER AT THE PROPERTY INDICATE BELOW HOW MANY TO ADD AT AN ADDITIONAL COST OF R60.00 PER PERSON

Membership for Domestic workers who live off the property @ R60 p/person p/month

B&B Beds @ R40 p/Bed p/month

Start date of membership

Notes

Person responsible for account

Preferred debit date

By submitting this form, I/we agree to subscribe to the service in accordance with CMR's Standard Terms & Conditions which are available on request and on CMR's website: www.cmr-med.co.za I/we confirm that I/we have read and understood the terms and conditions and agree to the terms thereof. All prices increase on the 1st of April each year.

I/we hereby authorize Cape Medical Response to debit my/our account with the total monthly premium indicated above. I/we understand that a charge of R110 will be levied for any debit-order non-payment/s.

Please note this form will only be sent if you have ticked the "I'm not a robot" box above AND clicked on the "submit" button below.
Should you not hear from us within 24 working hours something is not right - please call Mark on 082 851 7645 or email mark@cmr-med.co.za