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Online Registration & Payment

Please complete the following form to register for the 2012 CPD-Well programme.


Note that you must only proceed with this option if you intend on paying by credit card. However, if you prefer to pay by cheque or electronic transfer then refer to the "Registration" page.

*First Name:
*Surname:
*Initials:
*Title:
*HPCSA Number:   (enter your HPCSA number)
*Address:
 
 
*Postal Code:
*Tel (W):
Tel (H):
Fax:
*Cellphone / Mobile:
*E-mail:
Referred by:
*Language:
*Password:
*Retype Password:
*Courses:   CPD Option A 2012
  CPD Option B 2012
  CPD Option C 2012 - General
  CPD Option C 2012 - Industrial
  I have acknowledged and diarized the closing date of the programme as 2012/12/07



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