Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Medical Professional's Full Name *FirstLastEmail *Department *Dues *Active/Provisional Physicians – $200.00Dentists – $200.00Midwives – $100.00Nurse Practitioners Active at KGH – $100.00Please note : Associate, locum, consulting, and temporary physicians are not required to pay dues. Dues Professional's Full Payment *Please direct any questions you may have to Liechen Naude at liechennaude@gmail.com.Submit
