NOFSA ORDER FORM

Name:

MP number:

Subspeciality:

Postal address:

E-mail:

Cell phone number:

Fax number:

Telephone:

MY ORDER: Amount



NOFSA ANNUAL MEMBERSHIP: Clinicians

Allied health care professionals

R400 R300

NOFSA/IOF TRAINING COURSE(Non-members) R2 500

NOFSA/IOF TRAINING COURSE (New NOFSA Member)^*** R1 750

10 CEU BOOKLET (Exec Summary) R250

10 CEU BOOKLET (New NOFSA Members) R190

25 CEU BOOKLET (Full Guideline) R350

25 CEU BOOKLET (New NOFSA Members) R250

Full guideline booklet (unit price) R150

Summary guideline booklet (unit price) R75

TOTAL

***Registration fees for the 4^th NOFSA/IOF Advanced Training Course in 2009 was R2,500.

METHOD OF PAYMENT:

 Cheque:

Please send cheque + completed order form to: NOFSA, PO Box 481, Bellville, Cape Town, 7535

 Electronic transfers:

Bank: ABSA Branch code: 505-210

Account name: National Osteoporosis Foundation Account number: 911 979 2397

Reference: Surname

Signature: ____________________________________

PLEASE FAX TO: 021-931 7075

NOFSA ORDER FORM