Join PatchSA – Membership Registration Form

Existing PatchSA members

If you are an existing member of PatchSA wanting to pay your annual fees, do not fill in the form below. Please just skip to the PayFast buttons at the end of the page or find our banking details here to pay via EFT.

To join PatchSA

If you wish to become a member of PatchSA, please fill in the form below and then click on the PayFast button to pay your fees to pay using a Visa card, Zapper or SnapScan. Alternatively you can pay via EFT using our banking details.

PatchSA Membership Form

Name(Required)
Address(Required)
Choose the correct membership category.
If you chose 'Other' for the profession/designation, please tell us your occupation or profession.
Do you have a formal qualification in paediatric palliative care? (E.g., PG Diploma or Master's)(Required)
Please provide the name of the organisation or institution where you are you presently employed. Write N/A if you are not employed.
PatchSA Medical WhatsApp Group(Required)
If you are a healthcare professional, do you wish to be added to the PatchSA Medical WhatsApp group?
Please provide any additional information you wish to share with us.
Protection of Personal Information (POPI)(Required)
Make me a member of PatchSA(Required)
This field is for validation purposes and should be left unchanged.

Pay or renew your membership fee

Once you’ve submitted your form, please pay your annual membership & joining 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 R200 for Community & Student Membership

Pay R300 for Nurse & Allied Professional Membership

Pay R400 for Doctor & Specialist Membership

Other payment methods

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.