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SA-ChilD membership 2022
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Option 1
Clear selection
Title
*
Mr
Ms
Dr
Prof
Rev
Advocate
First name:
*
Your answer
Surname:
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Your answer
E-mail address:
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Your answer
Cell phone number:
Your answer
Town / city where you are based:
*
Your answer
Province where you are based (if you are living in South Africa)
*
Gauteng
Western Cape
North West Province
Eastern Cape
Kwazulu Natal
Limpopo
Free State
Mpumalanga
Northern Cape
Not based in South Africa
Country where you are based (living/working)
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Your answer
Where do you work (i.e. your institution and department)?
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Your answer
Your discipline
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Physiotherapist
Occupational Therapist
Speech Therapists
Music Therapist
Remedial Therapist
Psychologist
Therapy assistant
Researcher
Paediatric neurologist
Orthopaedic surgeon
Developmental paediatrician
Neurosurgeon
Gastroenterologist
ENT surgeon
General practitioner
Medical doctor / medical officer
Parent / family member of a child/young adult with a childhood onset disability
Person with lived experience of childhood onset disability
Educator
Legal practitioner
Other
Required
Your HPCSA number (or equivalent if you are not in South Africa)
*
Your answer
Category of membership
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I live in South Africa and am not a student; or a person or family member of a person with a disability (R500)
I live outside of South Africa (R250)
I am a family member of a person with a childhood onset disability (R250)
I am a student (R250)
I have paid my membership fees
*
Yes
No
I paid my membership fees via
*
EFT
Snapscan
I have not yet paid
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