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RuDASA Membership form

RuDASA membership form.

Application form for membership to the Rural Doctors Association of South Africa.

Title(*)
Please type your full name.

Name(*)
Please type your full name.

Surname(*)
Please type your full name.

E-mail(*)
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Postal address
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Postal code(*)
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Place of work and District(*)
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Province(*)
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People outside out Africa please tick "other"

Country
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Home telephone
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Work telephone
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Fax
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Cellphone(*)
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Please tell us a little about where you are employed.
In what sector are you employed?
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Nature of employment(*)
Please specify your position in the company

Doctor = community service officer, clinician, doctor in academic or management post/ Other Health Professional = dentists, nurses, therapists, pharmacists etc in any post/ Undergraduate student : ONLY for those who have not completed their 1st health degree and internship/ Health Advocate = NGOs active in health advocacy

What position?(*)
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Students please specify course, university and year
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Council registration number (MP, IN, PT, etc)(*)
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You can say "None" if you are not required to be registered with one of the Health Councils. Health students are registered with HPCSA

Do you have any additional qualifications and/or special interests?
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Do you speak any languages other than English?
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Membership Rates(*)
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Required membership(*)

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Doctor = community service officer, clinician, doctor in academic or management post/ Undergraduate student & intern: ONLY for those who have not completed their degree/ Post graduate students should select another category/ Other Health Professional = dentists, nurses, therapists, pharmacists etc/ Health Advocate = NGOs active in health advocacy

RuDASA Values & Conduct
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Click on Our Values box to download these documents

If you would like to be a member that donates to RuDASA please click the Continue Button when you have submitted your Membership Form. It will take you directly to the PayFast site.