Select CategoryMembers of SNMBSenior Members of SNMB (>60 Yrs / Retd.)Members of SNMB (Medical Officer/Scientific Officer)Non-membersMembers of SNMTBResidents/Students
Name:
Address:
Mobile:
E-mail:
Do you have accompanying persons? NoYes
DOB:
Child 1 Name: DOB:
Child 2 Name: DOB:
Child 3 Name: DOB:
Registrant/Delegate Fee
Accompanying Persons
Total BDT
0 BDT
2,000 × 0 = 0 BDT
