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Convention 2016 registraion

Name (required)

Designation

Specialty

Instition/City

Address (required)

PMDC Registration No

Email (required)

Phone No (Res:)

Mobile phone no

PIMA Membership                Yes No

Accommodation required    Yes No

Amount deposit details

Amount

Bank

Date of amount deposit

Demand Draft/ Pay Order can be made in favour of “Pakistan Islamic Medical Association”
Account No. 069301010018844, Branch Code 0693, Muslim Commercial Bank (MCB), G.T. Road Peshawar.

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