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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.

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?

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