Registration

Application for Membership

To the secretary, PCMA : I hereby apply to join the PCMA/ renew my membership and agree to abide14 by its Code of Conduct and pay all dues promptly.

My application is for :

       Individual Membership

1. Individual Managed Care Pharmacist  ( annual membership R345 Early Bird option applies @ R320 before March 2009)*

 

1. Individual related Healthcare Professional i.e. other than Managed Care Pharmacists*

*Annual membership = R345
Early Bird payment before March = R320
10 or more = R310

 

Full Name:

Professional qualifications:

Company where employed:

Physical Address of Company:

Postal Address: code:

Tel: Fax:

Cell:

E-mail:

Individual Member