Paediatric Nephrology Society of Bangladesh

Membership Application

Department of Paediatric Nephrology · BSMMU · Block-D, Dhaka-1000
Phone: 8626167 · pednephbd@yahoo.com

Personal information

Basic applicant details

Name of the applicant (block letters)

Father's name

Year of graduation

Postgraduate degrees

Add each postgraduate qualification

Degree 1

Degree

Institute

Year of passing

BMDC registration no.

Current posting

Where you work now

Present place of posting / institution

Present position held

Experience in paediatric nephrology

Relevant roles and duration

Experience 1

Position

Institute

Duration

Membership type

Select one option

General Membership Standard membership for practising members Life Membership One-time life membership Associate Membership For associated professionals Honorary Membership Honorary / invited membership

Contact & mailing

How we can reach you

Mailing address *

Telephone / mobile *

Fax (optional)

E-mail *

Application date

Membership fee 10 BDT Secure online payment via shurjoPay