Vista Clinic

facebooktwitterpinterestbloggoogleplus

Contact Us +27 (0)12 664-0222
  • image
  • Fun Run Register
  • image
  • image
  • image
  • Happiness Helps
  • image
  • image
Previous Next

CPD Seminars: Book Online

 

 

 

 

 

 

Please complete the registration form below and fax your proof of payment to: (086) 651-3172 or e-mail  This email address is being protected from spambots. You need JavaScript enabled to view it. by the closing date the Friday before each seminar.

Payment must be made by direct bank deposit, to:
Vista Academy Cheque
ABSA Bank Centurion
Branch 632005
Account Number 4083426295

Ensure that your proof of payment reflects CPD, your name and the date of the CPD you are paying for e.g. CPD, W.A. Smith - 1 February 2017.

Once we receive both sets of information your registration will be completed.

Click here for Downloadable version of Registration Form.

 

  1. E-Mail Address*
    Please enter a valid email address
  2. Full Name (s)*
    Please enter your name
  3. Surname*
    Please enter your surname
  4. Telephone Number*
    Please enter a valid telephone number
  5. Cellular Number
    Invalid Input
  6. Statutory council you are currently registered with:
    Invalid Input
  7. Statutory council registration number:
    Invalid Input
  8. The seminar/s you wish to attend:*








    Please select at least one seminar
  9. Enter the code to validate your submission*
    Enter the code to validate your submission Invalid Input
  10. *

    Please read and agree to our terms & conditions before proceeding.


.

 

globalA