Site Name

 Go 

ORDER CARD

Please note this website is currently out of service whilst we make some technical adjustments to the payments system.

No orders will be accepted until this notice has been removed.

Thanks for your interest. Do not complete the application form!

******************************************************

                                                  PRICES:    1 Principal Card:                            £12.50
                                                                    2 (or more) duplicated Cards:    £  8.99 each
                                                                    Foreign Language duplicates:    £10.99 each


Special Offer Codes (including Gift Voucher numbers) should be added later at CHECKOUT STEP 2, which is the last stage before proceeding to payment.

  my emergency data
   
Title:
First Name:
Surname:
Date of Birth:
   e.g. January 1, 1988
Nationality:
Blood Group:   e.g. 0+,0-,A+,A-,B+,B-,AB+,AB-
Medical Conditions:
e.g. Pacemaker, Diabetes, Epilepsy etc.
Medication:
Regular medicine
Allergies:
Life risk allergies e.g. Penicillin, Bee Sting etc.
   
  my contacts to call in case of an emergency (max 2)
   
First Name:
Surname:
Phone Number:   Place () around any
numbers dropped when
dialing internationally
e.g.(0)789 47xxx89
 
Alternative Phone Number:   
   
First Name:
Surname:
Phone Number:    Place () around any
numbers dropped when
dialing internationally
e.g.(0)789 47xxx89
 
Alternative Phone Number:   
   
  my doctor(s)
   
My Doctor's Name:
My Doctor's Phone Number:    Place () around any
numbers dropped when
dialing internationally
e.g.(0)789 47xxx89
 
   
My Specialist's Name:
Type of Specialist:
e.g. Cardiologist, *Lawyer etc.
*You may wish to add your Lawyer, rather than a medical specialist.
   
My Specialist's Phone Number:    Place () around any
numbers dropped when
dialing internationally
e.g.(0)789 47xxx89
 
   
   
  my SOS id card
   
Attach Photo here:
   
                         Quantity:
Select Language for Principle Card:  
   
                   Quantity:                          Quantity:
Add cards in duplicate languages:
               
               
               
   
Terms & Conditions