New Member Registration FormPlease DO NOT use this form for the RENEWAL of existing membership

Please note – all fields are required (must be filled in) unless otherwise indicated.
Please hover over the ? (question mark) to read more about what to enter in the field.

  Personal Information  
  Contact Details  
  Address Details  
  Intern Supervision  
  Membership Requirements, Malpractice Insurance and Payment Method  
  Online Demographics  
  1. What equipment do you personally use when surfing WEB SITES? (Select all that apply)    Desktop or Laptop Computer 
Apple iOS System
 Tablet - with a Touch screen which is at least 6" WIDE or more 
iPad Tablet
Android Tablet
MS Windows Tablet
 Smartphones or mobiles - screen smaller than 5" wide 
Android e.g. Samsung, HTC, Motorola
Windows phone
  2. What type of Internet Connection do you PRIMARILY use?  
  3. When are you able to access the internet to surf WEB SITES?  
  4. Do you have to share a computer, with other BASA MEMBERS, to access the BASA website?  
  5. Do you use your CELLPHONE to read and manage your emails?  
  6. What time of the day do you USUALLY read your PERSONAL emails e.g. Newsletters from BASA?  
  7. Which browser do you primarily use when surfing websites?  
  8. How often do you use the following social media networks?  
Social Media Daily Weekly Never
  9. How would you rate BASA's communications?  
  10. How do you want to receive communications from BASA?  
  11. If BASA had a private community network (e.g. advanced Facebook),would you use it to network with your BASA
  collegues? e.g for general networking and discussions, or research collaboration, or special interest groups etc.  
  12. Tell us what you think?  
  Terms and Conditions  

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Gauteng, South Africa
Registration: 107-094-NPO
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