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  
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  Contact Details  
  Address Details  
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  Professional  
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  Intern Supervision  
  Membership Type, Malpractice Insurance and Payment Method  
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  Create or Edit your Practice Details  
  General  
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  Practice Contact Details  
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  The address of the practice i.e. how a client will find you  
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  PRACTICE OWNER ONLY - Practice Accreditation Details  
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  PRACTICE OWNER ONLY - Virgin Active Details  
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  Member Survey - Demographics, Internet and Communications   

The members' feedback during the last registration period proves incredibly valuable in identifying and defining our overall approach to services rendered and member communications. We ask that you take just a few minutes to complete this survey - Thank you for your time.

  Please identify the PRIMARY sector in which you provide a biokinetic service  
?
  Internet Access  
  1. What equipment do you USUALLY 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 8" WIDE or more 
iPad Tablet
Android Tablet
MS Windows Tablet
 Smartphones or mobile device - screen SMALLER than 6" wide 
iPhone
Blackberry
Android e.g. Samsung, HTC, Motorola
Windows phone
  2. What type of Internet Connection do you PRIMARILY use?  
  3. Which browser do you primarily use when surfing websites?  
  4. Do you always have to share a computer, with other BASA MEMBERS, to access the BASA website and Learning Centre?  
  Communications and Information  
  6. Do you use your CELL PHONE to read BASA newsletters and your other emails?  
  7. What time of the day do you USUALLY read your PERSONAL emails e.g. Newsletters from BASA?  
  8. How do you want to receive communications from BASA?  
  9. How often do you use the following social media networks?  
Social Media Daily Weekly Never
Facebook
Twitter
Google+
LinkedIn
  Tell us what you think ...  
  Agreement of Terms and Conditions  
Please click this box to indicate your agreement:

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P O Box 12448, Clubview 0014, Pretoria
Gauteng, South Africa
Registration: 107-094-NPO
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