Member Application Form

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Practice Number (BHF/PCNS)

HPCSA Registration Number

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Practice Manager Information:

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Membership Type Full membership — R2079 per annumInternational full membership — R2079 per annumAssociate membership — R945 per annumInternational Associate membership — R945 per annum

I hereby apply to take up membership in the SA Rheumatism & Arthritis Association, the object of which is to negotiate with the funders of health care, managed care organisations, other health care providers and the suppliers of goods and services to the respective members of the Company, with a view to maximising the potential synergistic and rationalisation benefits for each member. I acknowledge that the Memorandum Of Incorporation are available for my inspection and I agree that the board may use the pharmaceutical/claims data as a means of enhancing the group.