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New Registration

New Member Online Application

We are busy testing and implementing this function for future use. Please fill in the form and click on Send Registration. You need to click on the link displayed on the page to download the completed Application in PDF format.


PERSONAL INFORMATION
Title:
Name:
Surname:
Maiden Name:
Birth Date:(YYYY-MM-DD)
Citizenship:
ID No:
Passport No:
Postal Address:
Practice Address:
City/Suburb:
Location on Map:
Tel (W):
Tel (C):
Tel (H):
Fax:
E-mail:

REGISTRATION WITH THE ALLIED HEALTH PROFESSIONS COUNCIL
HPCNA No:
Date of Registration:(YYYY-MM-DD)
HPCNA Client No:

QUALIFICATIONS
Educational Institution:
Basic Qualification:
Date of Qualification:(YYYY-MM-DD)
Post Graduate Qualification:
Date of Qualification:(YYYY-MM-DD)
Fields of Special Interest:

EMPLOYERS DETAILS
Name of Employer:
Work Address:
Tel (W):
Tel (C):
Tel (H):
Fax:
E-mail:

NEXT OF KIN
Next of Kin Name:
Relationship:
Contact Number:

Membership Type:


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Did you know?

Your workplace can be a health hazard - contact your physiotherapist to have it evaluated and arranged to suit your health


Latest News!
Find a Physio

Follow the link at the top labelled Find a Physio for an interactive map of NSP-member physiotherapists in Namibia!

Date Posted:2019-02-05

Postal Address:
Namibian Society of Physiotherapy
PO Box 23321
Windhoek
Namibia