Membership Form – PatchSA

Sign up to become a Member

PatchSA welcomes any families, caregivers and child-caring professionals including paediatricians, GPs, nurses, social workers, allied health practitioners, psychologists, counsellors, teachers and clergy to join us.

Please select *

First Name (for Companies /Organisations please give name of contact person) *

Surname *

Email *

Cellphone number *

Membership Category *

I am a: *

If 'other' please state:

Do you have a qualification in children's palliative care?

If you answered 'yes', please state your qualification in children's palliative care *

Other paediatric palliative care qualification:

Job Title *

Place of Employment (or Name of Company/Organisation) *

If you are a doctor, nurse, or allied health professional (e.g. physiotherapist) , would you like to join the Whatsapp group?

Yes, please
No, thank you

Postal Address *

Comment or Message

Make Me A Member *

I/ we wish to become a member of PatchSA and agree to abide by the terms of membership as set out above.

Phone

Once you’ve submitted your form please pay your annual membership fee by using the appropriate button below. You can also use these buttons to renew your annual membership and pay fees due. Thank you!

Pay via EFT, Zapper or Snapscan

CLICK HERE FOR BANKING DETAILS AND CODES

Pay R150 for Community Membership

Pay R250 for Nurse and Allied Professional Membership

Pay R350 for Doctor and Specialist Membership

We also accept EFT, Snapscan and Zapper details of which you will find here. We’ll be in contact via email as soon as your submission and payment reaches us.

Sign up to become a Member

Pay via EFT, Zapper or Snapscan

Pay R150 for Community Membership

Pay R250 for Nurse and Allied Professional Membership

Pay R350 for Doctor and Specialist Membership

Get in touch