Heart Failure Management Meeting Hermanus
5 October 2024 | The Marine Hotel | 08:00 - 13:00
Meeting Registration
*
Yes, I can attend (meeting is indicated for registered medical professionals)
Regret, I cannot attend
Delegate Information
*
Title
First Name
Surname
E-mail Address
*
example@example.com Please ensure this is correct as this address will be used to forward your CPD certificate
Mobile Number
*
Specialty
*
General Practitioner
Physician
Cardiology Fellow
Nurse
Pharmacist
Industry (Sponsoring Company)
Other
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.
Primary Hospital Affiliation
*
Type N/A if not applicable.
Practice Sector
*
Private Sector
Public Sector
Private & Public Sector
City (Please indicate your city/town not your suburb. e.g. Bisho, Cape Town, George, Polokwane, Qonce, Soweto etc)
*
Province
*
Please Select
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
HeFSSA acknowledges with appreciation unconditional Corporate Support from:
Submit Form
Clear Form
Should be Empty:
