SA-ChilD membership 2024

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Membership form for SA-ChilD (1 March 2024 - 28 February 2025)

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Title *

Name *

Surname *

HPCSA number (if you are not registered with the HPCSA, just say N/A) *

Are you registered with a Health Professions Council outside of South Africa *

If you are registered with a Health Professions Council outside of South Africa, please provide your registration number

Your e-mail address *

Your cellphone number *

Town / city where you are based

Which province? *

If you are based outside of South Africa, which country are you in?

Where do you work? *

Your discipline *

Physiotherapist

Occupational therapist

Speech and Language Therapist

Audiologist

Dietician

Paediatrician

Developmental paediatrician

Paediatric neurologist

Neurologist

Orthopaedic surgeon

Gastroenterologist

ENT surgeon

General practitioner

Surgeon

Medical practitioner (if speciality not listed above)

Nurse

Educator

Music therapist

Legal practitioner

Co-ordinator / principal of a special needs centre

Person with lived experience of a childhood- onset disability

Family member / parent of a child/young adult with childhood-onset disability

Researcher / academic

Psychologist

Other

Required

Category of membership *

I have paid my membership fees for 2024 *

Yes

Not applicable

I paid my membership fees via *

EFT

Snapscan

I have not yet paid

Not applicable

Submit

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