ASAMI BANGLADESH

General Membership Application Form

1. Personal & Contact Details

a. Name *

b. Date of Birth

c. Mobile Number *

d. E-mail *

e. Mailing Address *

a. Academic Details

b. Time Since Post-Graduation (Years) *

c. BMDC Reg. No.

d) Position *

e) Institute *

a) Number of Ilizarov cases done in last 6 months *

b) Number of presentation in morning session or any orthopaedics conference *

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Your path to our community.

Initial Fee

3,000 BDT

Annual Renewal Fee

1,000 BDT

(Per Year)

Note: Renewal is mandatory annually.

I declare upon my honor that I shall abide by all the rules and regulations of the society and will not do anything subversive to the society.

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