IVPD > Member Account

February 06, 2012

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Member Profile Management

Complete the Application form for the IVPD Membership and the Shareholders Details form and fax or email them through to the IVPD, together with proof of payment.

Click to download forms:

Application for IVPD Membership form
Shareholder Details form

Send Application, Shareholder's Details and Proof of Payment to:

Fax to: 086 672 6949
Email to: ericadeg@iafrica.com
Payment: R4,845-00 inclusive of VAT

Once you have completed the above forms and made payment you will then need to complete the form below in order to receive your login details.

User Registration

*Note: Membership to this portal is Private. Once your account information has been submitted, the portal Administrator will be notified and your application will be subjected to a screening procedure. If your application is authorized, you will receive notification of your access to the portal environment. All fields marked with a red arrow are required. - (Note: - Registration may take several seconds. Once you click the Register button please wait until the system responds.)

User Name:

First Name:

Last Name:

Display Name:

Email Address:

Enter a password.

Password:
Confirm Password:

Practice_Name

Postal_Address

Region:

Enter the Postal/Zip Code part of the address

Postal Code:

Telephone:

Cell/Mobile:

Photo:


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