Renal Care Society of SA - Membership Application

Membership Application Form

Personal Details
Title		SANC/HPCSA Registration nr
Surname		First Names
Postal Address		Town
Code		Province
Telephone		Cell
Email
Work Details
Primary Employer
Employer/Hospital
Work Address		Town
Code		Province
Telephone		Cell
Email
Professional Cat.		Position/Rank
Involvement
Membership
Fees (Indicated by Type of Member): Payable on application and thereafter on 1 July of every year
Fees
Payment Method
Cheques & Postal orders should be crossed and made payable to the: RENAL CARE SOCIETY OF SOUTH AFRICA Bank deposits and electronic transfers: Fax proof of payment to 012-421 6735 Banking details: Bank: ABSA Branch: Hatfield (Code: 632005) Current Account Number: 1056991138