ASSA

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	Executive Committee

	Constitution

	CPD Update

	Become a Member

Become a Member

THE ASSOCIATION OF SURGEONS
OF SOUTH AFRICA

affiliated to

THE SOUTH AFRICAN MEDICAL ASSOCIATION
Incorporated Association not for gain. Reg No. 05100136108

MEMBERSHIP APPLICATION FORM

Name:	*
Postal Address:

Code:
Telephone:	*
Fax:	*
Email:	*

SURGEON
Private Practice
Full Time Hospital Practice
Registrar	Visit: www.sassit.co.za to register
Special Interests in
Surgery

Member of other groups
SAGES
SRS
VASSA
Trauma
SASES
Other

Annual Subscription 2010
Surgeon	R950 per annum
Registrar	Visit: www.sassit.co.za to register

Total Due:

Anti-spam	Sum of 7 + 5 ?

(CHEQUES MUST BE MADE PAYABLE TO ASSA PERSONAL TRUST) PAYMENT SHOULD BE SUBMITTED WITH THIS APPLICATION FOR MEMBERSHIP

Banking Details

ASSA Personal Trust
Nedbank: 1009323423
Branch: 100909 St George’s St, Cape Town

To download the Membership Application Form.
click here[PDF]
You will need to print and fax it to the following number: 086 556 2232