Registration Form for Symposium / Workshop / PUGA Membership PUGA Membership Registration TitleMr.Ms.Full Name Qualification Academic Designation Place Of WorkPresent AddressPermanent AddressPhone(Res.) Mobile Number Phone(Hospital/Clinic) E-mail Address CNIC PMDC# Consultants Registration FeeLife Member Rs. 10,000/- (SRs, Consultants, FCPS/MCPS/MRCOG/MS/DGO)Associate Members Rs. 5000/- (Postgraduate Trainees/SMO/Urologist/Allied Health Professionals)Associate Members Rs. 3000/- (Nurses/Midwife/Physiotherapist)Kindly upload your bank voucher for payment verification of membership fee/renewal. Membership fee on account payable to Pakistan Urogynaecologist Association. Account Details: Bank: Habib Metropolitan Bank Ltd. Branch: Rashid Minhas Road Branch. Account Title: Pakistan Urogynecologists Association. Account#: 6-99-72-29301-714-163524. IBAN#: PK23MPBL9972177140163524.Upload Your Picture Upload PhotoUpload Your PictureUpload CNIC / Passport Copy Upload PhotoUpload CNIC / Passport CopyUpload Bank Payment Voucher Upload PhotoUpload Bank Payment VoucherPUGA Secretariat: Pakistan Medical Association House, Sir Agha Khan III Road, Karachi - 7440. Phone: 021-32251159 Fax: 021-32231534 Email: [email protected] / [email protected] Website: PUGA Official Website Only fill in if you are not human
