Altor Staff Registration Form New

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Name(Required)
Date of Birth
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You MUST have your own email address to be able to register on this system. You can get a free email address at GET A FREE GMAIL ADDRESS

Gender(Required)
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Physical Address(Required)
Postal Address
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Choose a username
Choose a Password(Required)
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Please make a note of the Username and Password that you create. You will need it to log in to the system!!

Highest Medical Qualification Achieved(Required)
CPG Updates(Required)
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    Accepted file types: jpg, gif, png, pdf, jpeg, heic, Max. file size: 5 MB, Max. files: 2.
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      Accepted file types: jpg, gif, png, pdf, jpeg, heic, Max. file size: 5 MB, Max. files: 1.
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          Accepted file types: jpg, gif, png, pdf, jpeg, heic, Max. file size: 5 MB, Max. files: 1.
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            DD slash MM slash YYYY
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            DD slash MM slash YYYY
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            Accepted file types: jpg, gif, png, pdf, jpeg, heic, Max. file size: 5 MB, Max. files: 1.
              DD slash MM slash YYYY
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              DD slash MM slash YYYY
              Operational Experience(Required)
              CPD Compliant(Required)
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                CPD Notice here
                Additional Courses
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                    Current Employment(Required)
                    Locum Permission(Required)
                    Do you have permission to do locum work?
                    Locum Permission Statement to be added here
                    Transport(Required)
                    Driver Licence(Required)
                    Drivers Licence Code(Required)
                    PDP(Required)
                    DD slash MM slash YYYY
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                    Accepted file types: jpg, gif, png, pdf, jpeg, heic, Max. file size: 5 MB, Max. files: 1.
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                      Drop files here or
                      Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 5 MB, Max. files: 1.
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                        Drop files here or
                        Accepted file types: jpg, jpeg, gif, png, heic, Max. file size: 5 MB, Max. files: 1.
                          Drop files here or
                          Accepted file types: jpg, jpeg, png, gif, heic, pdf, Max. file size: 5 MB, Max. files: 2.
                            Are you a Medical Aid Member?(Required)
                            Consent

                            I hereby consent to the following :

                            a. We may use the contact details provided by you to contact you relating to Altor Emergency Medical Services. This may include SMS and/or email communication.
                            b. To the storing of my data for and on behalf of "Organisors" as part of their compliance with the Occupational Health and Safety Act no 85 of 1993, National Health Act 61 of 2003, Safety at Sports and Recreational Events Act 2 of 2010 and all it's current and subsequent regulations as are amended from time to time.

                            I understand that I can request my data to be deleted at anytime by sending an email to admin@project-pass.co.za but should I request this deletion my access to Project Pass and my access pass itself will become null & void and any cards provided or purchased must be surrendered on request.

                            You must scroll to the end and agree to the terms of registration
                            Clear Signature
                            Max. file size: 512 MB.
                            Upload Signature
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