Membership Application Form

* Required fields

Title:    
*First Name: *Surname:
Qualifications:
(Please include dates)
Please indicate your sector type: Public / Academic Sector
Private Sector		    
Institution Name: Department:
Institution Address: Physical Address:
Telephone:    
Town/City: Fax:
Province: Mobile:
Postal Code: *Email:
Country: *Verify E-Mail:
Please advise if we may add your email address to the AFRAN website? Yes
No
Notes (if any):

Please select the category which is applicable to you. For more information on these categories, please click here.

Full Member Categories
Fee per annum
 
Total
Qualified Adult Nephrologist
70 USD
Qualified Paediatric Nephrologist
70 USD
Specialist Physician
70 USD
Specialist Paediatrician
70 USD
Trainee / Fellow (1st years fee will be waived)
30 USD
Associate Member Categories
Fee per annum
 
Total
Paramedic, Nurse, Biomedical Engineer, Technician, Pathologist, Research Scientist
70 USD
Other - Please specify
Honorary Member
Fee per annum
 
Total
Honorary Member
Complimentary
Collective and Society Membership Fees Please contact the Secretariat for more information (info@afran.org)
Corporate Membership Fees Please contact the Secretariat for more information (info@afran.org)
Total:

Payment of Membership Fees

Once your membership is approved, the AFRAN Secretariat will send you an invoice for payment and you may settle payment by; bank transfer, credit card or Paypal. More details on these payment options will be sent to you as well.

Type this number into the box alongside: