Application Form
"Compassionate health care in the service of Christ"
Application Form
"Compassionate health care in the service of Christ" |
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MEMBERSHIP APPLICATION FORM : SEND TO
WE/I WISH TO APPLY FOR MEMBERSHIP OF CATHCA AS (please mark appropriate section)
NAME ... .... ... POSTAL ADDRESS ... CITY ... POSTAL CODE .. ... TELEPHONE . FAX CELL PHONE EMAIL ... FUND RAISING NO . VAT REGISTRATION NO. ..
. .. .. Name of Applicant/Contact person Signature .. . Position held Date
IF OTHER THAN CLINIC OR HOSPITAL, PLEASE BRIEFLY DESCRIBE YOUR ORGANISATION OR WORK and attach any explanatory documentation:
PLEASE ENCLOSE PAYMENT: R 800 for clinics, R 400 for Organisations R 100 for individual membership RECOMMENDATION OF LOCAL BISHOP (if an Organisation) .. .. . Bishops Signature Date
ACCEPTANCE BY CATHCA BOARD . Chairpersons Signature Date
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