SASGO

About us

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Member Registration

SOUTH AFRICAN SOCIETY FOR GYNAECOLOGIC ONCOLOGY APPLICATION FORM

Name:
Address


Telephone number
Cellphone number
E-mail Address

MEMBERSHIP NUMBER CATEGORY
Full membeership
Associate membership
Membership number(If available)

PAYMENT FEES
	Joining Fee	Annual Fee
Full membership	R400.00	R200.00
Associate membership	R200.00	R100.00
	Total fees

ELECTRONIC PAYMENT:

FNB Account number 62096292174 Branch number 200109
(Please put surname as reference when paying online and send completed application by fax or post)

SASGO ADDRESS

For the attention of :Dr MH Botha FAX NUMBER: (021) 938-4648
Unit for Gynaecological Oncology
PO Box 19063
Tygerberg Hospital
TYGERBERG
PAROW 7505