Agribonus Membership Number/Lid Nommer:
Identity Number/Identiteits Nommer: *
Title/Titel: *
—Please choose an option—MrMrsMissDrProfDs
Initials/Voorletters: *
First Name/Noemnaam:: *
Surname/Van: *
Sex/Geslag: *
MaleFemaleWould rather not say
Language Preference/Taalvoorkeur: *
AfrikaansEnglish
Physical Address/Fisiese Address: *
Postal Code/Pos Kode: *
Tel No:
Fax/Faks:
Cell Nr/Sel No: *
Do you want to receive cellphone communication?/Wil jy selfoon kommunikasie ontvang? (You can choose more than one option): *
SMSWhatsAppNone
Email/E-pos: *
Do you want to receive Email campaigns?/Wil jy e-pos veldtogte ontvang? *
YesNo
Preference for Bonus magazine/Voorkeur van Bonus tydskrif (You can choose more than one option): *
Hard Copy/Harde KopieEmail link/E-pos skakelSMS link/SMS SkakelWhatsApp link/Whatsapp SkakelNone/Geen
Business Name/Besigheidnaam:
Farm name/Plaasnaam:
Are you a member of a South African Hunter organisation?/Is jy 'n lid van 'n Suid Afrikaanse jag organisasie? *
[group show-org-input clear_on_hide]
If yes, what organisation do you belong to?/Indien ja, aan watter organisasie behoort u: *
If possible, please provide your hunting organisation membership number/Indien moontlik, wat is u jagter organisasie lidnommer:
[/group]
Please indicate if you purchase at one or more of the following co-operations: / Dui asseblief aan of u by een of meer van die koöperasies aankoop: *
AfgriAgri TuinroeteBKBCoastalsGWKHinterlandKaap-AgriKLKNTKNWKObaroOverbergOVKSenwesSSKSuidwesVKBTWK AgriOther
[group coop-purchase-other clear_on_hide]
If other, please specify/As ander, spesifiseer:
Do you have pets?/Het jy troeteldiere? *
Cat/sDog/s
Het jy ‘n mediese fonds /Do you have medical aid?*
Mediese fonds / Mediacal aid:
Kan ‘n Bonus Health konsultant jou kontak / Can a Bonus Health consultant contact you?*
Are you a farmer?/Is jy 'n boer? *
[group farmer-true clear_on_hide]
Crop Production/Akkerbou: *
None/GeenMaize/MieliesWheat/KoringVegetables/GroenteFruits/VrugteVineyard/WingerdOther/Ander
Cattle/Beeste: *
None/GeenMeat/VleisMilk/Melk
Sheep/Skaap: *
None/GeenMeat/VleisWool/Wol
Pigs/Vark: *
None/GeenYes
Goats/Bokke: *
Chicken/Hoenders: *
None/GeenLaying Hens/Lê-HenneBoilers/Braai
Game/Wild: *
By clicking on 'Submit', you are actively consenting to our processing of your personal data as per our Data Protection (POPIA) terms
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