SAVA Wildlife Group Membership Application Form

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Email *

Title *

Name & Surname *

Professional Council registration Number *

Please insert your SAVC or your local veterinary council number if registered outside of South Africa

Cell Number *

Telephone Number

Registered Practice Name/Organisation/Private

Organisation or Facility Street Address

Postal Address *

VAT no:

Company tax no such as VAT, or other if required for your invoice

Province *

Eastern Cape

Free State

Gauteng

KwaZulu-Natal

Limpopo

Mpumalanga

Northern Cape

North West

Western Cape

Other:

Sector(s) *

Private Practice

State

Academia

Industry

Non South African Resident Vet

Undergraduate student

Other:

Required

I will abide by the Constitution of the SAVA Wildlife Group *

Link to constitution: bit.ly/WLGConstitution

Yes: I will abide

Are you a South African Resident/Active member of SAVA *

South Africa Resident with active SAVA membership

Non South African Resident

Non South African Resident with Active SAVA membership

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