TMC 2025 Registration Form – South African Society of Travel Medicine

NAVIGATION

STANDARD REGISTRATION FORM

QUALIFICATIONS:

Please complete the Registration Form below (all fields are compulsory) – please note: an acknowledgment of receipt of your registration form will be sent to your email address supplied from admin@sastm.org.za. Payment instructions will only be given once your Registration has been accepted by SASTM and Wits University, (please note that not all applications will be accepted if they do not conform with the criteria outlined).

TMC 2025 Registration Form:

Cost: R 11 750.00 incl. VAT

Company / Clinic Name:

Company / Clinic Physical Address:

Physical Address:

City:

Province:

Postal Code / Zip Code:

Country / Region:

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Phone Number – Work:

Cellphone Number:

VAT Number:

Practice Number:

Personal Information:

Title:

First Name:

Last Name:

Gender:

ID Number:

Job Title:

Profession:

Personal Email Address:

Please note: your email address is very important and it will be used to register you on the Student Portal for Course Information and Presentations (should you be accepted on the Course) – this cannot be changed at a later date, and you should have easy access to this email account (at work and at home).

Postal Address:

Postal Address:

Postal City:

Postal Province:

Postal Code:

Postal Country:

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Medical Registration Board: HPCSA / SANC / Allied Health / Pharmacy Council / Other?:

Medical Registration Number:

Do you have any dietary requirements: Halaal / None?:

Please note: If you require Halaal meals, please note that there will be a

surcharge of R 1 700. Incl. VAT added to your invoice.

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Qualifications (including year of completion and institution) – all applicable:

Post Graduate Experience (including work / study, institutions and dates):

Short Motivation for Attendance:

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Overseeing Doctor?: (This is applicable to all Nurses, Allied Health and Pharmacy Council – no exceptions): Yes / Not Applicable:

Name of Overseeing Doctor:

Year Overseeing Doctor completed the Travel Medicine Course:

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