Online Workshops 1-5 Registration Form

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A Series of Practical Workshops in Medico-Legal Practice by SAMLA / UCT Law@Work

Important Information

Registrations open on Wednesday 1st April 2020.

All participants must be a SAMLA member in good standing.

Once we have received your completed registration forms, we will forward you an invoice. The invoice will contain the bank details and a payment reference number which you must use when effecting payment.

Certificates and CPD letters will be issued in the name of the participant as supplied on the application form.

Practitioners registered with HPCSA will earn CPD points for each workshop completed. CPD letters indicating the awarded points will be issued by UCT. (SAMLA has no influence on the number of CPD points awarded by the HPCSA).

In addition SAMLA will issue medico-legal CPD points for all registered medico-legal practitioners. (applicable to the SAMLA register of Medico-Legal Practitioners)

Participants who successfully complete the Foundations Course and all Workshops 1-10 (whether live or online, irrespective of the order) will earn a Certificate of Competence in Medico-legal Practice.

Successful completion of all 10 workshops will have the following two important benefits:
o CPD Points both HPCSA & SAMLA Medico-Legal CPD
o Eligibility of higher levels of registration for SAMLA Register of Medico-Legal Practitioners
Details to be determined by the SAMLA Board

Title (eg. Mr/Mrs/Ms/Dr/Adv) *

First Name (Preferred Name) *

Surname *

Name for Certificate *

Email *

SA ID Number *

Date of birth: *

YYYY

Gender *

UCT student number (if applicable):

Occupation: *

Company

Name of applicable professional registration authority: (eg. HPCSA)

Your professional registration number with applicable authority:

Postal Address *

Work Telephone Number

Cellphone Number *

Which Workshops will you be completing *

Workshop 1- Traumatic Brain Injury.

Workshop 2- Psychological Consequences, Emotional Shock and Constitutional Damages. Monetary and Non-Monetary Compensation.

Workshop 3- RAF 4 Assessment and Recommendations.

Workshop 4- Cerebral Palsy.

Workshop 5- Mediation (For Mediators, Attorneys, Advocates, Expert Witnesses).

Required

Please ensure your SAMLA membership is up to date. Participants must be a SAMLA member in good standing.

Payment Option (with CPD points and Certificate) *

Option 1 - R26,400.00 for all workshops, payable on receipt of invoice

Option 2- Monthly – R2,550.00 per month payable by the last day of each month for 12 months

Option 3- Per workshop selected – payable on receipt of invoice (access will only be given on receipt of payment) – R7,200.00 for 3 day workshop and R4,800.00 for 2 day workshop.

N/A (I will be doing CPD only option)

Payment Option (with CPD Points only)

Option 1- R23,900.00 for all workshops, payable on receipt of invoice

Option 2- Monthly – R2,350.00 per month payable by the last day of each month for 12 months

Option 3- Per workshop selected – payable on receipt of invoice (access will only be given on receipt of payment) – R6,700.00 for 3 day workshop and R4,300.00 for 2 day workshop.

N/A (I will not be doing the CPD only option)

Clear selection

Who will be paying for you to attend this invoice

My Employer / Company

I am paying for myself

Clear selection

Invoice details

Please note: Individuals and companies will be emailed a statement and payment details on registration.
Please do not complete this section if you are paying as an individual.
Please ensure that you complete this information as it should appear on the invoice.
Invoices will be emailed to the contact person indicated below. Please ensure that you give the correct person’s details.
Note that the attendee’s participant number must be used as reference for the payment. This participant number will appear on your invoice. Do not make payment until you have received the invoice.
Once payment has been made, proof of payment must be sent to admin@samla.co.za.
If payment is unlikely to reach us before the start of the course, we require a letter from your company stating their intention to pay the fee on receipt of an invoice.

Name of Company (only applicable if being paid for by Employer/Company)

Postal Address

Physical Address

Vat Reg Number

Purchase Order Number

Contact Person for Invoice

Email address for Invoice

Telephone number for payment follow up

Would you like to join the UCT Law @ Work Mailing List? *

Terms & Conditions

We will acknowledge receipt of your registration form.

Only EFT payments or bank deposits will be accepted.

Once we have issued a participant number to a participant, cancellations cannot be refunded. (Participant numbers are assigned once registration is completed.)

By submitting this registration form I become liable for all fees payable for the workshops I have registered for.

By submitting your registration for the SAMLA Workshops, you expressly give SAMLA, Azlyn Creative and UCT Law@Work permission to use your information for the purpose for which it is intended.

This includes but is not limited to sharing your contact information with the above organisations and other participants as required by the syndicates in which you will be required to complete course work and others as required from time to time. You will receive email from the SAMLA Faculty and be added onto the Forum for the Workshops and syndicates.

I accept the above terms and conditions *

Yes

Required

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