Membership form

Name

First Name Last Name

Contact details

Email address

example@example.com

Gender

Date of birth

Residential address / postal code

Province

Language

Membership category

Main member (Person's with disability) Family member Friends

Type of disability

Employment status (not compulsory)

NB: please make a note that our membership is R20 pa

Banking details
Account holder: Disabled Women Living With Dignity
Bank name: FNB
Account number: 62829664219
Branch code: 252645

Disclaimer: Once you have registered with the organisation, you give us the right to advocate for you and use the resources we have to our fullest capabilities.

Are you a robot? *