Re-activate my account FoH Number* ID Number* Delivery Option* E-mail POST to Postal address POST to Physical address Courier Online WhatsApp Email* Cell Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Select a payment option* Once-off payment Monthly payment Banking Details Bank Name: ABSA Account Type: Cheque Account Nr: 405 843 7431 Branch Code: 632 005 Ref No: HPCSA noDebit Order Details Membership runs from January to December of each year. Therefore the debit order amount will depend on the month in which you join. A membership fee of R125 will be added to the first month’s installment. If applicable, the courier cost of R70 will also be deducted with the first month’s installment. Thereafter only the installments as set out below will be deducted until December 2016.When did you open your account at your Current Bank?* Bank Name* Type of Account* Account Number* Branch Code* Branch Name* Account Holders Name* Preferred Debit Order Date* 1 15 25 30 Abbreviated name as it will appear on your bank statement* ID Number* Additional commentConfirm you give consent in terms of the Protection of Personal Information Act and the terms and conditions as below.* Terms & Conditions Focus on Health membership represents an annual subscription. Membership fees will be due and payable once Focus on Health has emailed, couriered, posted, provided online access or personally delivered accredited activities to the member. For the members’ convenience, membership is renewed on the last day of the calendar year. Following which Focus on Health will provide the member with his/her new CPD activities for the next year via the selected delivery option and details provided above. It is the members’ responsibility to inform Focus on Health of any changes. All membership cancellations should be submitted twenty (20) business days before the renewal date of 31 December of each year. Please contact us if you did not receive your membership number and login detail via SMS within 24-36 hours. Please contact us within two weeks after submitting this application if you did not receive your CPD activities. All correspondence and receipt of payments sent to Focus on Health will be confirmed via SMS. As part of your membership we reserve the right to communicate with you via WhatsApp, SMS, telephone or email regarding the delivery of your CPD activities, statements and accounts, changes in CPD compliance as communicated by statutory bodies and any other important information relating to our management of your CPD membership and status. Protection of Personal Information Act, (Act 4 of 2013) I hereby give my consent freely and voluntary that Focus on Health (Pty) Ltd and its employees may collect, process and store my personal data, such as my name, surname, identity number, e-mail address, telephone address and assessment outcomes. I understand that Focus on Health (Pty) Ltd uses an external courier company to deliver packages and that by providing my address and contact details to the company the courier company may also receive these details when delivering a package. I understand that my personal information as recorded and stored by Focus on Health (Pty) Ltd is protected under and in full accordance with the Protection of Personal Information Act, (4 of 2013). Any additional personal information that is supplied by myself will be subject to the same standard of confidentiality and protection. I understand that I have the right to withdraw, verify or change my information held by Focus on Health (Pty) Ltd and that I may request access to the information which was collected and processed by Focus on Health (Pty) Ltd. I further understand that I am free to withdraw this consent at any time, provided that I inform Focus on Health (Pty) Ltd of same in writing. If there is reason for me to believe that my personal information is not processed in the correct manner or that it is used for other purposes than what it was intended for, I may contact the information officer/deputy information officer of Focus on Health (Pty) Ltd. Your personal information will be processed according to our Privacy Statement. You are welcome to request a copy at any stage. Confirm you give consent to receive marketing communications as specified below MarketingI consent that my personal information may be used by Focus on Health (Pty) Ltd to bring new products and services, that fall outside the scope of my membership, to my attention and understand that I may opt out from receiving such marketing communications at any time. CAPTCHA Δ
