Please Fill in the blank boxes bellow in the capital latterDateNameDesignationAddress/Institute:Phone (Whatsapp)Email AddressSelect Your CategorySelect Your Category* Professor/ Chief Cardiac Surgeon (Amount of Payment 2500/-)* Associate Professor/ Senior Consultant (Amount of Payment 2000/-)* Assistant Professor/Junior Consultant/ Post graduate Doctor (Amount of Payment 1500/-)* Register /Assistant Registrar/Medical Officer (Amount of Payment 1000/-)* Resident (Amount of Payment1000/-)* Nurse/Perfusionist/ Technician (Amount of Payment 1000/-)Total Amount of payment In WordPayment Method In RegistrationCashBkashNagadPayment InformationBkash Or Nagad Account NumberBkash Or Nagad Transaction IDSignatureStart signing your signature hereYour browser does not support e-Signature field.Submit
