Register with us Dialysis Association of South Africa Username* Email Address* Password* Confirm Password*Applicant's ID or PassportUpload Applicant's ID or Passport UploadA Company ResolutionUpload A Company Resolution UploadProof of registration and good standing with the Health Professions Council of South Africa or the South African Nursing Council.Upload Proof of registration and good standing with the Health Professions Council of South Africa or the South African Nursing Council. UploadCertificate of incorporation (CM1) (if applicable)Upload Certificate of incorporation (CM1) (if applicable) UploadTitle First Name* Last Name* Name of Business Phone Number Mobile Number* Hospital/ Dialysis Centre Physical Address or Business Address Town/ City Postal Code Province HPCSA or SANC Number Private Practitioner?YesNoPractice Number Qualifications Membership CategoryOrdinary MembershipHonorary MembershipCorporate MembershipInstitutional MembershipCategory / Practice FieldDialysis Centre OwnerClinical Technologist B Tech (Only independent practitioners with ownership interests in a private dialysis practice)Business Field (Please specify)Hospital Group with dialysis interestDialysis Nurse with an ATA noticeClinical Technologist B Tech (Independent Practitioner)Medical Doctor: Physician/ Nephrologist/ Other with a dialysis interestOther ( please specify)How many dialysis centres do you have?* Which provinces do you operate in?*Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern CapeBusiness Field Other Nominated by Seconded by VAT Number Declaration 1I agree to abide by the Constitution and Code of Conduct of DASA at all times.Declaration 2I agree to pay an annual subscription fee as determined by DASA. I acknowledge that failure to pay the subscription fee on an annual basis and to pay the annual registration fee will result in my membership being revoked. Only fill in if you are not human
+27 12 3456 789 
secretary@dasa-sa.co.za
+27 12 3456 789 secretary@dasa-sa.co.za