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. NASEEMA KAPADIA GENERAL SECRETARY  (2011-2012)		DR NAEEM IQBAL TREASURER (2011-2012)
Encl: Photocopies of Degrees, Diplomas and Valid P.M.D.C. certificates A Valid PMDC Certificate is required with Endorsed Postgraduate Qualifications. 2 P.P SIZE Photographs (INCOMPLETE FORMS SHALL NOT BE ACCEPTED)