APPLICATION FOR SASS MEMBERSHIP Before you apply for SASS membership: All Applicants need to be proposed and seconded by two (2) SASS members who are familiar with the professional standing of the prospective member. Please contact the members beforehand and request that they support your application. Click to familiarise yourself with the Requirements & Processes for SASS Membership Click (+) below and complete all Personal Info before submitting. 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Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard & Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States of America Uruguay US Minor Outlying Islands USSR (former) Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe I wish to apply for -- Please select -- Full Associate Affiliate Registrar Intern Your Personal Info Contact Details This section is for record purposes and will be treated private and confidential Email Title : -- Please select -- Adv Dr Miss Mr Mrs Ms Past Prof Rev Preferred Name Surname Full First Names Initials Country Code + Mobile (+27XXXXXXXXX) ID Number -- Please select Country of Birth -- Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czechoslovakia (former) Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories F.Y.R.O.M. (Macedonia) Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain (UK) Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent & the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles S. Georgia and S. Sandwich Isls. Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard & Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States of America Uruguay US Minor Outlying Islands USSR (former) Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Date of Birth (yyyy-mm-dd) Spouse / Partner Name of Spouse Surname of Spouse Home Address Home Address 1 Home Address 2 City Region Postal Code Home Telephone Professional Info This section will appear on [Find a Doctor] of the SASS website for public search purposes Profession Abbreviated Qualification Business Info Business Address 1 Business Address 2 City Region Postal Code Business Postal Address Business Postal Address Postal City Postal Region Business Postal Code Business Telephone Business Cell Business Email Business Fax Business Website I have read and understand the Terms of Use Click to see Terms of Use After you have completed the information the Complete Application button will appear You will receive an email to confirm your application and instructions to complete the rest of your application SA Spine will contact you Submit