Membership application

Apply to join Pro-Medical

Complete the form below and send it straight to the cooperative. It takes about ten minutes.

Personal information

First name

Surname

SA ID or passport number

Date of birth

Telephone / cell

Address

Street address

Suburb (optional)

City or town

Province

Postal code

Work and professional details

Occupation or profession

Registration body (optional)

e.g. HPCSA, SANC, SAPC

Registration number (optional)

Anything else we should know? (optional)

Supporting documents

Optional now — you can also send them later. PDF, JPG or PNG, up to 10 MB each.

Copy of ID or passportChoose a file

Proof of addressChoose a file

Professional registration (where applicable)Choose a file

Declarations

I have read the Constitution of Pro-Medical Primary Cooperative and agree to be bound by it.

I understand that membership requires paying the membership fee and purchasing the required membership shares, that each member has one vote, and that any surplus allocation is not guaranteed.

I consent to Pro-Medical processing my personal information to assess this application and keep the member register, in line with the Protection of Personal Information Act (POPIA).

You'll receive a reference number straight away.