COSOSA Membership Portal
I would like to become a COSOSA Member
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Yes
No
Confirmation
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I confirm I am a Specialist Medical Practitioner, actively involved in cardiology and/or cancer care (Member)
I confirm I am Medical Professional (other than a specialists), actively involved in cardiology and/or cancer care (Associate Member)
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@cososa.org
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Yes
No
Member Information
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Title
First Name
Surname
E-mail Address
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example@example.com
Mobile Number
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Speciality
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Cardiologist
Cardiology Fellow
General Practitioner
Haematologist
Medical Oncologist
Medical Oncology Fellow
Pharmacist
Radiation Oncologist
Radiation Oncology Fellow
Radiologist
Specialist Physician
Surgeon (General)
Surgeon (Specialist)
Medical Council Registration Number (Complete with Council abbreviation followed by number for example: MP 0123456, SANC 12345678, P 0123456, etc.)
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Type N/A if not applicable.
Primary Hospital Affiliation
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Type N/A if not applicable.
City
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Country
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South Africa
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