Membership Form - for Institutions

As PACAM Institutional Member, representatives from your organization will be invited to regional update meetings each year where you are updated on palliative care progress in and outside Malawi, and will present organizational views at the annual general meeting.

Institutional Membership Category	Institutional Membership Fee
Standard Membership	K5,000.00
Bronze Membership	K10,000.00
Silver Membership	K15,000.00
Gold Membership	K20,000.00

First make a deposit into our bank account below for your specific membership type. You will need a scan of your deposit slip or picture of wire-transfer/proof of payment to complete this online form.

Bank details:

Account name: Palliative Care Association of Malawi
Bank name: National Bank of Malawi
Account number: 2837234
Branch : Lilongwe
Swift code: NBMAMWMW007

Registration Form:

Required *

Institution

Pllease state the name of the institution.

Postal Address

District

Status of Registration

Membership number

If you are renewing your membership, please insert your membership number above.

Year of First Registration

If you are renewing your membership, please state which year you first joined us. If you have forgotten the day or month default to 1 January and select the correct year.

Services Offered

Please state above the services your institution offers.

Institution type

Select above which type of institution you are.

Last Name (of key contact person)

Please state the Last Name of Key contact Person

First Name (of key contact person)

Please state the First Name of Key contact Person.

Sex/ Gender

Position

What is the organisational position of they key contact person at your institution?

Phone number

Fax number

E-mail address

Please give us the email address you would like us to reach you at.

Proof of payment

Name of Form Applicant

If you are not the key contact person you have stated, please enter your name above.

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Membership Form - for Institutions

Registration Form:

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