ISPOR SA Chapter Membership Application Form

Membership Application Form
YesNo
Please note that consent is required to complete this form.
Industry/Private @ R1,690.00 per annum per personGovernment/Academia @ R1000.00 per annum per personFull-time Student/Non-profit Entity* Annual Membership Fee is waived if you provide proof of current registration
*Please note that all student memberships will expire after one year. Students must reapply for exemptionn after the year has passed (with proof of registration) or full membership rates apply.

* Non-profit memberships will expire after one year. Members must reapply for exemption with proof of non-profit registration.
I am a student/NGO member. No invoice neededI have an existing invoice for 2026 ISPOR SA MembershipI would like to request a single proforma invoice (for myself only)Please contact me to arrange a group invoice for myself and my colleagues
I am self-fundedI am funded by my organisation
Billing Details of Person/Company/Institution Responsible for Bill*
This address will be used to issue Membership Invoices
Full names of colleagues who must be included on the invoice:*
Total Number of Colleagues on Invoice*
Industry Membership
Government/Academia Membership
Total
Main Applicant Information*

TitleFirst NameLast Name
Upload Proof of Registration as Full-time Student/ as a Non-Profit Entity.

Cancelof
Relevant, Highest Qualifications*
Example: MSc (Health Economics)
Current Institution/Organisation/Company*
University/Academic InstitutionData Analytics or Real-World Evidence (RWE) ProviderDevices/Diagnostics IndustryGovernment Agency/Statutory BodyHealth Care Providers/Hospital NetworksHealth Technology Assessment (HTA) AgencyHEOR/Market Access/Pricing ConsultancyManaged Care Organization (MCO) or AdministratorMedical SchemeNGO or NPO with HEOR FocusOther ConsultingPharmaceutical IndustryOther
Consulting in HEORData ScienceEpidemiologyHealth EconomicsHealth PolicyHealth Plan AdministrationMarket AccessMedical AffairsPharmacoeconomicsPharmacy Benefit ManagementReimbursementRegulatory AffairsResearch (Academia)Research (NGO)Research (Private Sector)StatisticsOther, please specify
Mobile Number*
Telephone Number (Office)
E-mail Address*
example@example.com. Please ensure this is correct as this address will be used to forward your proforma invoice
Country
Province*
City*
Please send me a Proforma Invoice (use billing details provided)I am a Student/ Please send me a Proof of Membership
YesNo
Education/LearningStaying up to date on latest trends in SAStaying up to date on the latest trends globallyNetworking opportunities
In the last two years, which ISPOR SA offerings produced the most value to you?*
Do you have any feedback for ISPOR SA such as topics or opportunities to consider/areas for improvement?*
YesNoOther
www.isporsa.co.za
Should be Empty: