Student Membership Application Form

Enter your order number from your fee payment confirmation email
DD slash MM slash YYYY

Next of Kin Details

(Next of Kin) Name(Required)
College / University | Course Title | Mode of Study
Does your course include practical clinic hours? If so how many?
(note this will be in the future)
MM slash DD slash YYYY

Upload Section

Drivers licence, Passport or student card
Accepted file types: jpg, png, pdf, Max. file size: 5 MB.
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
Please upload your confirmation of enrolment or evidence that you are a student at an accepted tertiary institution.