Register for Admission to CMSA Examinations
Personal Details
Please provide the following details to register with The Colleges of Medicine of South Africa. Records marked with a * are required.
If you see
, there is a problem with the information you have provided.
If you see
, the information you have provided is acceptable.
|
|
Surname*: |
|
|
|
Maiden Name: |
Leave blank if not applicable
|
|
|
Full Names*: |
|
Please provide the following data for statistical purposes only:
This information is required strictly for statistical purposes to assist the CMSA and the Government in ensuring that the demographics of the registrars writing and passing CMSA examinations, are changing. The CMSA remains committed to maintaining confidentiality, it regards the information as privileged and will never disclose the information to examiners as per a resolution adopted by Senate.
You may choose not to divulge this information.
|
| I am willing to divulge this statistical information:
|
|
|
Gender*: |
|
|
|
Race*: |
|
|
|
Marital Status*: |
|
|
|
Postal Address*: |
|
|
|
Postal Code*: |
|
|
|
Country*: |
|
|
|
Mobile Phone: |
You may only use '+' and the digits 0-9 to enter your phone number, for example +27821234567 or 0821234567
|
|
|
Work Phone: |
You may only use '+' and the digits 0-9 to enter your phone number, for example +27111234567 or 0111234567
|
|
|
Do you have a South African ID Number?*: |
|
|
|
Identity Number*: |
|
|
|
Passport Number*: |
|
|
|
Email address*: |
|
|
|
Password*: |
Your password should have at least 7 characters, at least one upper case letter, at least one lower case letter, at least one number, and at least one symbol from the set !@#$^&()_+=[{}]|:,/<.*?>
|
|
|
Retype Password*: |
|
|
|
Medical Council*: |
|
|
|
Council Registration Number*: |
|
|
|
Council Registration Date*: |
|
|
|
Security Question*: |
What is the answer? 7 + 8 =
This question protects your data from being accessed by viruses and other internet based computer programs.
|
|
|
|
processing...