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Become a member of FIDSSA

MEMBERSHIP APPLICATION
New members are kindly requested to complete the online form

Title
Initials *
Surname *
First name *
Council Number
Telephone *
Fax *
Cell *
Email *
Postal address *
 
Region
Postal code
Institution of Practice *
Speciality *
 
Select the society that you would like to be primarily affiliated to

Which affiliated society(ies)would you like to receive information from ?*
 

Doctors

Associate Members
Doctors
Associate Members
Nurse & Allied Professionals

Nurses and Affiliate
Members
Honorary member
ICSSA
STDSSA
IDSSA
SASPID
SASCM
 
To become a member of SASTM please Click here
 

2010 fees including vat are as follows:
Doctors - R250,
Nurses and Allied Professionals - R150,
Associate members (Doctors) - R150,
Associate members (Nurse and Allied Professionals) - R100,
Honorary members - no charge.

Method of Payment:


Cheques should be made out to the “Federation of Infectious Diseases Societies”. If payment is made by direct deposit or electronic transfer, please mark the deposit slip clearly with your Initial and Surname and fax a copy to 0866 349 839, or e-mail info@fidssa.co.za

Only once receipt of payment has been received will you be registered as a FIDSSA member and only then will your membership details be sent to you.

All payments must contain your initials and surname as reference for payment. Please Fax or e-mail proof of payment through to the FIDSSA office.


 
Cash
Cheque
Bank Transfer
Credit Card
   

Banking details:
Standard Bank,
Branch: Jan Smuts
Branch code: 004205
Account No: 001894986

Anti-spam : **Sum of 6 + 4 ?



Contact FIDSSA on:

Tel: 079 491 7109
Fax: 086 634 9839
e-mail: info@fidssa.co.za



Click here to download form

 

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