Emergency Care Society of South Africa

Apply for ECSSA Membership

Title:
First Name:
Last Name:
Prof. Registration Number:
Address:
City:
Province:
Postal Code:
Country:
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Fax:
E-mail:
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Profession:
Membership:
Select a membership fee option below:
This cycle (remainder): This cycle and next:

By clicking the Apply button below you confirm that you have read and agree to ECSSA's protection of private information disclaimer.

Please take note of the following:

This is an application for membership and does not, on its own, confer membership on the applicant.
Membership applications will be confirmed by email, to the email address supplied in the application form.
The applicable membership fee must be paid into ECSSA's bank account, and proof of payment submitted to either membership@ecssa.org.za or (fax) 086 551 9469.
Once proof of payment has been received, active membership will be confirmed by email to the email address supplied in the membership form.
Membership fees are shown in the table at left.
The membership fee must be paid into ECSSA's bank account:

ABSA Bank
Branch: Davenport (Branch Code: 632005)
Account Number: 4074446626
Reference: Professional (HPCSA) Registration Number