Apply for Membership

MEMBERSHIP APPLICATION

Tel: 012 314 0185 | Cell: 0713589903 | Email: info@curamusassociation.co.za

Surname *

Full Names *

Force Number

ID Number

Residential Address

E-Mail *

Cellphone

Tel Work

Tel Home

Arms of Service

Unit

Attestation Date

Years of Service

Rank or Title

Mustering

Highest Qualification

Nature of Disability

Date of Injury

Percentage Disability (%)

Medical Classification

Current Job Status

Description of Current Job (if applicable)

Current Income

How Did You Sustain Your Injury?

Was It An Injury On Duty?

Pension/VPA or NPO Number

Name

Relationship

E-Mail

Cellphone

Tel Work

Tel Home

Relevant Disability Equity Training (if applicable)

Are You A Member Of Any Veterans Organisation?

Recreation/Sport Activities

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