Register Title*--Please select--MrMrsMissMsDrSurname* First Name/s* EQASA number (if relevant) or CEEPSA number to update information ID Number* Citizenship*--Please Select---South AfricanSadecOtherPlease Specify Your Country of birth (if not SA) Date of Birth* YYYY slash MM slash DD Home Telephone Number*Cellular Telephone Number*Email Physical Address Line 1* Physical Address Line 2 Physical Address Line 3 Postal Code of Physical Address* Postal Code Line 1 Postal Code Line 2 Postal Code City/Suburb* Province*--Please select--The Eastern CapeThe Free StateGautengKwaZulu-NatalLimpopoMpumalangaThe Northern CapeNorth WestThe Western CapeQualification Category*-- Please Select --Apprentice (Still to do Exam)GroomHead GroomStable Yard ManagerStud ManagerAssistant InstructorInstructor (International Level 1)Coach (International Level 2)Coach (International Level 3)FarrierComplementary Health TherapistEquine Assisted TherapistOther (Please Specify)Specialization Please Specify your Qualification Category Population (Equity)*--Please Select--AsianBlackColouredIndianWhiteGender*--Please Select--MaleFemaleHome Language*--Please Select--AfrikaansEnglishisiNdebeleisiXhosaisiZuluSesothoSesotho sa LeboaSetswanasiSwatiTshivenḓaXitsongaOtherAre you disabled?--Please Select--YesNoCurrent Employment Status*--Please Select--EmployedUnemployedStudentPlease state the nature of your disability Additional Qualification 1 Supporting Document Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 32 MB. Additional Qualification 2 Supporting Document Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 32 MB. Additional Qualification 3 Supporting Document Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 32 MB. Date of Expiry of First Aid Certificate (if applicable) MM slash DD slash YYYY Copy of First Aid Certificate (If applicable)Max. file size: 32 MB.I agree to having my name published on the CEEPSA database and SAQA NLRD. This will be visible online. (Optional)* Yes No CEEPSA Membership fee :* excluding Personal Accident Insurance for Member & Staff: R400 including Personal Accident Insurance for Member & Staff: R450 Code of Ethics* I hereby accept to abide by the Code of Ethics of CEEPSA NameThis field is for validation purposes and should be left unchanged. Banking details Absa Bank 409 793 1703 Name of account – Council for Equine and Equestrian Professionals of South Africa