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
Special Interests in
Surgery

Member of other groups
sages
SRS
Vassa
Trauma
SASES
Other

Annual Subscrition 2009
Surgeon	R850.00 (Includes SA Journal of Surgery)
Registrar	R200.00

I en close:

(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: (011) 484-2717