Subscription Form CHOOSE the type of subscription: * Gold Silver Bronze Name of facility * Organisation/membership/Affiliation Street address * Suburb * City/Town * Province * Telephone number with area code Cell phone number * E Mail * Website Link If you have one Is your development less than 2 years old? (If so, we will feature you in our “New developments” section) Yes No Does your facility have a video? Yes No Monthly Stats Every month we send out statistics on the number of visitors who viewed your listings Name of the marketing person to whom the stats will be sent to * Email address of the marketing person * Billing Information Email address to which monthly invoices must be sent * Alternative Email address to which monthly invoices must be sent * Name of the person to whom monthly invoices must be sent * Phone number of the person in charge of monthly payments * Company Name to be shown on invoice * Company Address Company Registration VAT Number of Company If applicable Choose type of payment * Monthly debit order 6 monthly payment in advance PLEASE NOTE: Clients are not asked to sign long term contracts. Debit orders can be cancelled at any time by giving us a calendar month notice. If you have opt for the 6 month payment in advance, on renewal, you simply tell us that you do not wish to re-subscribe and we will downgrade your listing. Type of Facility Tick the boxes pertaining to your facility (Very important) * Retirement Villages Offering Apartments / Flats Offering Cottages Offering Rentals Sold on Life Rights Sold on Sectional Title With Midcare / Frail Care With Visits by a Nursing Sister Pet Friendly Old Age Homes Offering Day Care Offering Hospice Care Offering Short Term / Holiday Care With Dementia / Alzheimer’s care With Frail Care With Midcare / Assisted Living Frail Care Centres Specialised Dementia Care With Dementia - Alzheimer’s care Step down/Post Operative Care Facility registered with medical aids Specialist Rehabilitation Centre Subsidized Places Subsidized Retirement Villages Subsidized Old Age Home Subsidized Frail Care Centre