Annual Masac Membership Form

ANNUAL MASAC MEMBERSHIP FORM

PLEASE COMPLETE ANNUALLY AND UPDATE DETAILS

I would hereby like to register as a member of the SAHF MASAC for the YEAR2016

I have read and endorse the mission statement as contained in Article 2 of the constitution of MASAC (next page)

I would like to receive MASAC information and Updates by Email YES NO

I do actively participate in the management of Haemophilia Patients YES NO

Particulars of MEMBER

First Name: ______

Last/surname: ______

Name of Hospital/Institution: ______

Position e.g. doctor, nurse ______

Organisation/Employer: ______

Name of Hospital / Haemophilia Centre______

Current Position (eg Physio, Nurse, Doctor, Labret) ______

Email Address: ______

Delegate Contact Numbers: Work No ______

Cell No: ______

Fax number: ______

Registration no for CPD points: ______

SANC Number for Nurses:______

PLEASE REGISTER BY 30 APRIL 2016

NB PLEASE RETURN THE MEMBERSHIP FORM AT YOUR EARLIEST CONVENIENCE.

PLEASE FAX PAGE TO 0862444664; or Scan to e-mail or complete on line version

My main interest in SAHF MASAC is ______

Signature______

Date______

Article 2. Mission statement

The aims and objectives of MASAC are:-

2.1To create and promote outreach programs aimed at identifying People with Haemophilia (PWH) and other bleeding disorders in Southern Africa.

2.2To keep an accurate national register of PWH and other bleeding disorders.

2.3To promote and practice the highest quality of clinical care of people with haemophilia (PWH) and other bleeding disorders.

2.4To develop, standardize and critically evaluate new and existing treatment guidelines for PWH and other bleeding diathesis.

2.5To endorse and support programs engaged in the implementation and promotion of home based therapy and training of healthcare workers.

2.6To promote the acquisition, dissemination and application of knowledge about bleeding disorders to healthcare workers, health administrators, health insurance industry and government health organs.

2.7To identify unique problems affecting people with bleeding disorders in South Africa, Africa and rest of the world.

2.8To promote and enhance scientific enquiry into these problems.

2.9To provide a forum for discussion of these problems through national working groups, scientific meetings and publications.

2.10To encourage and promote collaborative activities among MASAC members and other national and international organizations.

2.11To promote and participate in regional, national and international programs of the World Federation of Haemophilia.

2.12To assist in the implementation of the World Federation of Haemophilia programs in Africa and other third world countries.

NPO No. 039-436-NPO