Become a member

Sign-Up Form

Step 1.

Pay your membership fee of a R1000 to

ABSA (Current Account)
Account Number 4053614575

Be sure to use your name as a reference and send the proof of payment to webmaster@dermatology.co.za

Step 2.

Complete the electronic membership registration to receive via email your Log In details.

Step 3.

You will receive a form to complete with nominations and further details. Please complete the form and email back to Dr Jonathan Smith.

Complete the form below to register:

First name *

Last name *

Title *

Member Type *

Your email address *

Choose a password *

Confirm password *

Tel (H)

Tel (W)

Mobile *

Physical Practice Address *

City / Town *

Country *

Your HPCSA number *

Special Interests

What topics would you like covered in the future?

By clicking on create account’ you agree to our Terms of Use. Click here to read the Terms of Use

I understand and agree to the Terms of Use *

Answer 5 + 12 = ?