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New Registration for The BAFM
By filling up this form I am requesting the organization to enroll me as a Life Member of the Association)
* Indicates required question
Name
*
Your answer
Sex
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Graduation (MBBS) pass out year
Your answer
Designation
*
Your answer
Registration Number and year with name of the Medical Council
Your answer
Email
*
Your answer
Address (Mailing address with pin code)
*
Your answer
Phone number (WhatsApp)
*
Your answer
Write the Transaction ID with date below
(Fees to be paid Rs.2500)
[You can scan the QR code below from any UPI app or use the UPI address directly.]
UPI ID: 9433584848@sbi
*
Your answer
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