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Name of Organization/Individual

Your Email (required)

Postal Address

City

Postal Code

Province

District

Sub-District

Diocese

Telephone

Cellphone

E-Mail Address

VAT Reg Number

NPO Number

PBO Number

We/I wish to apply to Cathca as one of the following (Please Select One):

If other than a clinic or hospital, please briefly describe your organisation and attach any necessary explanatory documentation

Supporting Documentation (if necessary)

PLEASE ENCLOSE PAYMENT or DEPOSIT DIRECTLY
Standard Bank, Rosebank branch R150.00 for Organisational membership
Acc: CATHCA No: 00 187 6279 R50.00 for individual membership
Branch code: 00 4305 12 Diocesan groups to be discussed

If payment has been made, kindly attach proof of payment belor:

Name of Applicant/Contact person:

Position Held