Registration ESPEN Block Membership 2020
Register at SASPEN
Title
Mr
Mrs
Miss
Ms
Dr
Prof
HPCSA (or Nursing Council) number
HPCSA number. eg. DT0012345, all in CAPITALS
First Name:
Last Name:
Postal Address:
Postal Code:
Country:
Work Number:
Cell Number:
Email Address
Date of Birth (DD/MM/YYYY)
SASPEN Member?
Yes
No
Category:
Physician/Surgeon
Nurse
Dietician
Pharmacist
Nutritionist
Other (please specify)
If Other:
Membership Category:
South African Member
SADC Country Member
International Member
Member Type:
New Regular Members - 90 Euros
Former Regular Members - 90 Euros
Junior Members (up to 32 years old) - 40 Euros
Senior Members (from 65 years old) - 40 Euros
Contact Information