New Page – Association of Certified Chaplains in South Africa

Registration

You may register online. In order to register online you will need a working email address and your South African identity numb

If you are unable to register online, you may submit a paper registration by printing the form from the link Registration Form pdf, and sending it to the Registrar at the address indicated on the form.

Complete the online registration form and email the documents below to the Registrar at registrar@ccinsa.co.za

- Payment confirmation

- Copy of ID

- Highest Qualification

(Should you experience any technical difficulties during the online registration prosses

or if we do not reply within 24 Hours, please send us an email to follow up)

BANKING DETAILS

Payment can be made to Association of Certified Chaplains in South Africa

First National Bank, Mossel Bay, Branch - 210314, Account Nr. - 62854390087

Personal Information

Next of Kin

High School Education

Further Education

Membership Categories

Chaplaincy Experience

Professional Registration

Declaration

Title (Select one) *

Full Name/s *

Surname *

Identity Number *

Residential Address *

Postal Address *

Home Tel. No. *

Cell No. *

Email Address *

Language Preference (Select one) *

Name & Surname *

Relationship to you *

Home Tel. No. *

Cell No. *

Address *

High School Education *

Grade Passed *

School Name *

Year Attended *

Name of Institution / University *

Qualification/s (Select) *

Year *

List any other training or qualification you have received

Category Application (Select)

Compulsory Assessment Fee – R150.00 This assessment fee MUST be paid in addition to the following registration fees. If you are sure of your category, please select it below. Otherwise, our office will communicate to you your relevant category once the compulsory assessment is complete

Description of current and past chaplaincy experience

Other

Profesional Registration

Institution

Registration Status

By submitting this registration form means: 1. You understand and declare that the information you provided is correct. 2. You agree to comply with our Code of Ethics, Policies, Terms and Conditions and other documents. 3. You understand we are not responsible for our partners and affiliates actions, promises or liabilities of any kind.

Date of Application *

Please remember to email the following;

registrar@ccinsa.co.za

Payment confirmation

Copy of ID

Highest Qualification

(Should you experience any technical difficulties during the online registration prosses

or if we do not reply within 24 Hours, please send us an email to follow up)