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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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

Students please specify course, university and year
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What position?(*)
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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

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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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.