" /> Ophthalmological Society of Bangladesh | Member Registration


Member Registration

Name(In block letters)  :

Present Address           :

Telephone                      :

Permanent Address     :

Telephone                     :

Qualification Institution Year
1.
2.
3.
4.

Present Position Held                                            :

Any Difficulty Encountered in Present Position :

Any Other Information in favour                           :


Proposed By :
Name :

Address :

Seconded By :
Name :

Address :

Taka* :


Please select anyone* :

Transaction ID* :