HPBASA

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This Association is affiliated with the South African Medical Association (SAMA).

Any medical practitioner who is registered with the Health Professions Council of South Africa (HPCSA) is eligible for membership.

Membership fees have been set at R350 per year for members and R200 for junior doctors.

Please complete the following :

Title

First name

Surname

Identity / Passport No.

Specialty:

Professional Number.

E-mail

Mobile no

Resident in South Africa

Yes

If yes - SA Province

Postal Address

Code

Contact Details

Code

Tel no:

Code

Fax no:

I agree to be bound by the terms of the Memorandum and Articles of Association

Yes

Anti-spam

**Sum of 6 + 1 ?