Baby Club Application Form

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Ante-/Postnatal Care and Classes Consultations Baby Growth Monitoring Immunisations Developmental Milestones Mother Health & Wellness Home Births Breastfeeding Support Weaning ... and everything else! Book an appointment for your convenience. Tel 013 755 5500 Email: babyclinic@mopani.co.za Situated at Mopani Pharmacy Crossing Centre and I'langa Mall

For more information contact: babyclub@mopani.co.za or 013 755 5500 Crossing Centre, Nelspruit 013 755 5500 WhatsApp: 066 192 1703 I'langa Mall, Nelspruit 013 742 2225 WhatsApp: 066 315 9987 White River Square 013 751 2267/8 WhatsApp: 066 315 9995 Steiltes Shopping Centre, Nelspruit 013 590 7310 WhatsApp: 066 315 9998 Emergency A/H Number: 082 761 1603

Join our Family today!


My Mopani Card Number is:

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It won't cost you a cent to join. Simply complete the Mopani Baby Club Membership form attached ensuring that all sections are completed. You may join at any stage during your pregnancy.* It is however recommended you only apply after 13 weeks of being pregnant (due to the sensitivity of circumstances surrounding the first trimester of a pregnancy.) *Adoptive parents are welcome to join. T's & C's apply. Mom’s who have already had a baby but didn’t join the Baby Club during their pregnancy may apply for the Special Baby Bag. (see option 3) Please make sure you fill in your expected due date on the membership form. If you are already a Mopani Card Member you still have to register for Mopani Baby Club so that you can receive your special welcome pack and we can include you in all our Mopani Baby Club offers. If you are not a Mopani Card Member you will need to apply for a Mopani Card as your profile records your purchases (& value) and allows you to know firsthand and qualify for any promotional offers. Please note a new application is required for every pregnancy.

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When you first join our family you will receive a Baby Club Welcome Bag* (in-store immediately upon completing your application form) filled with useful information and samples.

Once your Mopani Card profile has been captured and active for three months or there has been a minimum spend of R350, you will be notified via SMS to come instore to collect your Second Bag. This gorgeous custom designed bag is filled with an informative baby guide and practical surprises sourced especially for you and your baby! Ÿ You will know first-hand of any promotional offers and workshops specifically tailored to meet the needs of your baby. Ÿ Follow our Facebook page @mopanibabyclub for fun competitions and useful articles! Ÿ

*bag contents will vary and is subject to change depending on availability of samples received and sourced items.

I don’t have a Mopani Card Name & Surname: ID Number: Cell No: Name of Spouse: Spouse Cell No: Email: Expected due date: Is this your first baby?

Yes

No

If no, please tell us about your other children: Child:

Age:

Child:

Age:

Do you already have a baby (younger than 2 years) and still want to join the baby club? Applicant’s Signature:

Date:

Which store would be most convenient to collect Baby Bag 2* from: Crossing

i’langa

Steiltes

White River

*Please note that you will be contacted regarding when you can collect Bag 2 from the store indicated.

Introducing an account that grows alongside your pregnant belly! Once your baby arrives, start using the funds accumulated to make baby's arrival a little easier on your pocket. You can use the money saved in the account for any purchase at Mopani Pharmacy - including immunisations from our Baby Clinic.

MOM-TO-BE ACCOUNT

Please note that your membership is linked to your Mopani Card

I do not live in Mpumalanga and would like my bags to be sent with my online order and understand that I will carry the courier cost to receive my bags if not sent with an online order. Where do you live: How did you hear about Mopani's Baby Club?

FOR OFFICE USE ONLY

Note: Once a debit transaction has been recorded on your account, Mopani Pharmacy will no longer credit you with R15 per R100 deposited. This account will automatically close 6 months after the due date supplied in the account application form. To apply for the account email accounts@mopani.co.za

Customer received Bag 1:

Bag 1 was issued by:

(Name of staff member)

Signature:

Date:

Special Baby Bag 3 for a baby already born: Age of baby:

Boy

Girl


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