Gastro(30-July-2025)CME Registration Form - Continuing Medical Education
Email *
Basic Information
First Name *
Last Name *
Specialty
*
Designation *
Qualification *
Institution *
Mailing address *
City *
Country *
CNIC No *
LNH employment No *
Passport No. (Optional)
PMDC Registration No *
Email Address *
Phone No *
Title of the Activity *
Name of Organizer/Planner *
Type of CME activity *
Payment details
(If applicable please fill the below details)
*
Payment Option
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Name of Bank
Challan/Draft No
Date *
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