Should you wish to join MTASA, please complete the MEMBERSHIP REQUEST form below and click “Submit”.

Please do not send any payment at this stage.

Once your request for membership has been processed the MTA secretary will contact with you with further information and a detailed account of fees due.

Membership Application Type:

Title:

Full Name:

ID Number:

Date of Birth:

Gender:

Postal Address

Residential Address

Place of Employment:

Contact Details:

Email:

Cellphone Number:

Home Telephone Number:

Work Telephone Number:

Fax Number:

Practice Details:

Allied Health Professional Council of South Africa - Registration No.:

Name of Training Institution:

Address of Institution:

Training Institution Telephone Number:

Principal and/or Trainer's Name:

Date Qualified:

I currently practice:

Period in Practice: