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Membership Registration

Surname *
First Names *
Identity number *
Qualifications
Occupation
Postal Address *
  *
Code *
E-mail : *
Tel No (H) :
Tel No (W) : *
Fax:
Mobile: *
My choice of communication:  
Mobile or Email Address
Post
WHASA Membership Number (if applicable)

WHASA Region
(select province by marking appropriate block)

   
I am NURSING PRACTITIONERS ONLY: SANC Reg
MEDICAL PRACTITIONERS ONLY: HPCSA Reg

Registration Number :

(SANC or HPCSA)

MEMBERSHIP:

 

 

Please register me for (select your option in the allocated blocks on left side of table)

 

INDIVIDUAL MEMBERSHIP

1 Year
   

FULL MEMBER (Please supply required SANC/HPCSA Registration number)

R 100.00

STUDENT MEMBER (Please supply proof of student registration)

R 100.00


Total amount
 

 

 

PAYMENT DETAILS:


Please deposit the amount relevant to your selection into the WHASA bank account and include the proof of payment with your application form.


WHASA Banking Details


Bank : Standard Bank
Branch : Brooklyn
Branch Code: 011245
Account No : 012966622

For other methods of payment, please call us at : 011-475-2902 or via e-mail at membership@whasa.org
 
 

 


* Download WHASA Membership Application Form