Convention 2016 registraion

Name (required)

Designation

Specialty

Instition/City

Address (required)

PMDC Registration No

Email (required)

Phone No (Res:)

Mobile phone no

PIMA Membership               YesNo

Accommodation required   YesNo

Amount deposit details

Foreign Delegate = 200 USDConsultant / Family Physician=Rs:4000/-Resident / Medical Officer=Rs:2000/-House Officer=Rs:1000/-Associate Member=Rs:500/-Additional Accompanying Person=Rs:500/-Pre-Conference Workshop = Rs:2000/-

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.