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Business Representative

First Name*

Last Name*

Email Address*

Phone Number*

Date of Birth*

ID Number*

Business Details

Registered Business Name*

Trading Name (the name other members will see)*

Business Website Address*

Business Email Address*

Business Phone Number*

Add your LinkedIn Profile URL (optional)

Business Address

Address Line 1*

Address Line 2*

Town / City*

Province*

Country

Use the same address as Postal Address

Corporate Account Users

First Name	Last Name	Email	Actions
Petrus	Swanepoel	@petrus.swanepoel@mediclinic.co.za

Service Offering

Service Name*

Write an overview about your business in relation to the healthcare sector and the SAFHE values. Please note, this information will be used in your profile that other members will see if your application is approved. You will be able to update this information in your member portal.*

Upload a business profile (only PDF files accepted)

Business Profile.pdf

Upload your business logo*

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Welcome Petrus

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