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PAKISTAN ASSOCIATION OF DERMATOLOGISTS
MEMBERSHIP FORM 

To,
The General Secretary,
Pakistan Association of Dermatologists.

Dear Sir,

 


I, Dr. , hereby apply to be enrolled as a Life Member of The Pakistan Association of Dermatologists. I have read the rules and regulations of the Association and agree to abide by them. My Curriculum Vitae are as follows:

 

LAST NAME

FIRST NAME

FATHER'S / HUSBAND'S NAME

ADDRESS

PHONE Residence

PHONE Clinic

PHONE Hospital

E-mail
  

MOBILE

DATE OF BIRTH

QUALIFICATIONS

 

 

PMDC Reg No.

APPLICANT'S SIGNATURE

 

 

 

 

 

PROPOSED BY

SIGNATURE

 

SECONDED BY

SIGNATURE 

 

 

 

Dr. Muhammad Shahid
GENERAL SECRETARY 
(2022)                   

Dr. Manzoor Hussain Memon
TREASURER
(2022)

Encl:
  1. MBBS Certificate
  2. CNIC Copy
  3. Post Graduate Degree
  4. PMDC/PMC Certificate, valid & showing Post Graduate Qualification.
  5. All 3 documents may be signed and stamped by the Proposer or Seconder
  6. 2 Passport Sized Photographs
  7. Pay Order/ Bank Draft of Rs 20,000/= in Favour of Pakistan Association of Dermatologists (Cheques not acceptable)
  8. Form for Life Membership may be downloaded and duly filled.
  9. Incomplete forms shall not be accepted


All may be send to General Secretary
Kashf's skin laser clinic, kohinoor city, opposite salt and pepper hotel, Faisalabad.
Or
DHQ HOSPITAL, DERMATOLOGY DEPARTMENT, FAISALABAD

03336502764

 


PAKISTAN ASSOCIATION OF DERMATOLOGISTS
DATA FORM LIFE MEMBER'S DIRECTORY

NAME
RESIDENCE ADDRESS RESIDENCE PHONE
CLINIC ADDRESS CLINIC PHONE
HOSPITAL ADDRESS HOSPITAL PHONE
E-MAIL

I WOULD LIKE TO RECEIVE MAIL AT

RESIDENCE              CLINIC              HOSPITAL
               (If any other address please give details)