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[MM_Form type=’checkout’ membershipLevelId=’1′]

[MM_Form_Message type=”error”]

[MM_Form_Section type=”accountInfo”]
Account Information

First Name: * [MM_Form_Field type=”input” name=”firstName” isRequired=’true’]
Last Name: * [MM_Form_Field type=”input” name=”lastName” isRequired=’true’]
Email: * [MM_Form_Field type=”input” name=”email” isRequired=’true’]
Password: * [MM_Form_Field type=”input” name=”password” isRequired=’true’]
Phone: * [MM_Form_Field type=”input” name=”phone” isRequired=’true’]
South African Citizen? * [MM_Form_Field type=’custom’ id=’4′ isRequired=’true’]
ID Number: [MM_Form_Field type=’custom’ id=’1′ isRequired=’false’]
Employer: * [MM_Form_Field type=’custom’ id=’3′ isRequired=’true’]
Gross Monthly Salary: (in Rands) * [MM_Form_Field type=’custom’ id=’2′ isRequired=’true’]
Preferred Payment Method: * [MM_Form_Field type=’custom’ id=’5′ isRequired=’true’]
Preferred Payment Period: * [MM_Form_Field type=’custom’ id=’6′ isRequired=’true’]
* indicates a required field

[/MM_Form_Section]

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[/MM_Form]

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