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New Member Application
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*
are required.
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Personal Details
Title
*
Select
Mr
Mrs
Ms
Miss
Dr
Prof
Rev
Please select a title.
First Name
*
First name is required.
Surname
*
Surname is required.
ID / Passport Number
*
A South African ID number will fill in your date of birth and gender automatically.
ID or passport number is required.
Date of Birth
*
Date of birth is required.
Gender
*
Select
Male
Female
Prefer not to say
Please select a gender.
Race
Select
African
Coloured
Indian
White
Other
Prefer not to say
Required for sports federation reporting only.
Contact & Address
Email Address
*
A valid email address is required.
Cell Number
*
Local format is fine, no +27 needed.
Cell number is required.
Home / Work Phone
Other Phone
Physical Address Line 1
*
Address is required.
Physical Address Line 2
Postal Address
City / Town
*
City is required.
Province
*
Select
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
International
Please select a province.
Postal Code
Membership Details
Member Type
*
Select
Transplant Recipient
Living Donor
Donor Family
Dialysis Patient
Supporter / Friend of SATSA
Please select a member type.
Occupation / Work Details
Select
Employed
Self-employed
Student
Retired
Unemployed
Other
Organ Transplanted
Select
Kidney
Liver
Heart
Lung
Pancreas
Bone Marrow
Cornea
Multiple Organs
Not Applicable
Year Transplanted
Hospital
Select
Groote Schuur Hospital
Red Cross Children's Hospital
Charlotte Maxeke Johannesburg Academic Hospital
Wits Donald Gordon Medical Centre
Netcare Milpark Hospital
Steve Biko Academic Hospital
Inkosi Albert Luthuli Central Hospital
Universitas Academic Hospital
Other
Sports Participation
Which sports would you like to participate in?
Athletics
Swimming
Cycling
Golf
Tennis
Table Tennis
Badminton
Squash
Tenpin Bowling
Lawn Bowls
Petanque
Darts
Volleyball
Walking
Track & Field disciplines (if Athletics)
100m
200m
400m
800m
1500m
5km
Long Jump
High Jump
Shot Put
Discus
Javelin
Ball Throw
Other activities or comments
How did you hear about us?
Source
Select
Hospital / Transplant Clinic
Friend or Family
Existing Member
SATSA Business Card
Social Media
Website / Google
Event
Other
Referred by (name)
Referrer email
Please enter a valid email address.
Referrer phone
Please add me to the SATSA newsletter mailing list
Consent
I consent to the South African Transplant Sports Association (SATSA) storing and processing the personal information provided in this form for the purpose of membership administration, in line with the Protection of Personal Information Act (POPIA).
*
You must give consent to submit the application.
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