Become a Member

Name:

Qualifications:

MP number:

SAMA number:

Practice number:

Practice type and address:

Contact details:

Landline:

Cell:

Fax:

Email:

Annual membership fee of R300.00 payable into SAGS account

PLEASE NOTE OUR NEW BANKING DETAILS:

Account name: SA Geriatric Society
Bank: Investec Bank Limited
Branch Code: 58 01 05
Type of Account: Current Account
Account Number: 10012911350

Please use your name as a reference.

Please note that unfortunately at present we are only able to accept applications from Medical Practitioners, due to regulatory requirements.

Please email the completed form and proof of payment to acoetzer802@gmail.com. Contact me if a fax number is required.

Welcome to our society!