SAHS Membership Renewal

SAHS Membership Renewal
CONSENT: I understand the purpose for disclosing this personal information. Collection of this information complies with The Protection of Personal Information Act 4 of 2013 (POPI), South Africa. If you have any questions about the Privacy Policy contact info@hypertension.org.za *

Yes No
Renew SAHS Membership *

Yes No
Member Information *

Title First Name Last Name
Email *
example@example.com
Mobile Number *
Please Select your fee category *

Specialist Fee R 500,00 Medical Practitioner Fee R 400,00 Other Practitioner Fee R 300,00
Medical Council Registration Number (Complete with Council abbreviation followed by number for example: MP 0123456, SANC 12345678, P 0123456, etc.) *
Type N/A if not applicable.
Profession *

Cardiologist Dietician Fellow General Practitioner Nurse Pharmacist Physician Physiologist Researcher Student
Organisation details
Hospital Organisation Affiliation *
Please select sector *

Private Public Private and Public
City *
Province *
Do you Require an Invoice *

Yes No
Membership Payment Process
Pay registration fee via EFT into the SAHS account.

An automatic summary email including the banking details will be sent to your nominated email address within a few minutes.

If you do not receive anything from us, please check your spam/junk box or contact: info@hypertension.org.za

Payment Reference: Initial and Surname

Email proof of payment to info@hypertension.org.za
Confirmation of Information *

I Confirm: I completed the SAHS Membership Renewal Form in my professional capacity. All provided information is true and correct.
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