Free Medical Alert Card

About you

Full name *

Cell number *

Email address *

What do you do? Tell us about your occupation or daily role *

Your lifestyle

How physically active are you? *

Mostly sedentary Light activity (occasional walks, gym now and then) Moderately active (gym 3×/week, weekend hikes, sport) Very active (daily training, outdoor adventures) Elite / professional athlete or coach

Do you have any medical conditions or take chronic medication? *

Yes No Prefer not to say

If yes, briefly describe (optional — helps us understand how LIFEfolio works for you)

Your reach

How many people do you interact with face-to-face in a typical week? *

Under 20 20 – 50 50 – 100 100 – 200 200+

Are you active on social media? Which platforms and roughly how many followers or connections?

Your fit

Why do you think LIFEfolio is a good fit for your lifestyle? *

If selected, what’s one natural way you’d show or share your Black Card with others? *

Your commitment

Are you comfortable using a smartphone to set up your LIFEfolio profile, scan a QR code, and help someone else do the same? *

Yes Yes, with a little guidance No

Who would you most naturally introduce LIFEfolio to? *

If selected, do you agree to complete your LIFEfolio profile before your card is shipped, use the card, and share it honestly when relevant? *

Yes No

Shipping for your Black Card *

I live in George I live outside George and accept the R50 courier contribution I live outside George and do not accept the R50 contribution