Direct Debit Member Form - Single Title * Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country year of birth * Email * Mobile Number * What activities are you interested in? Radio players Art appreciation Gardening group Bolivia Book discussion Bushwalking Caravan group Choir Computer group Computer lessons Cycling Five Hundred (cards) Four-wheel drive Golf – 9 and 18 holes Internet lessons Orchestra Photography Pleasure fishing Par 3 golf Snooker / 8 ball Social group Table tennis Tap dancing and variety Tennis Train the brain Weekly walkers If another activity, please specify Do you wish to be contacted by a representative of the group? * Yes No How did you hear about Retire Active SA? From a Retire Active SA member or group Visited website Visited Facebook page or was sent the link Found a link on another website Saw advertising material If by another source, please specify Thank you! If you have any questions, please contact us. *Required
