Membership Registration – Foreign

Name: Membership Registration - Foreign
SKU: 380
Price: 250.00 USD
Availability: InStock

$250.00

Category: Uncategorized

Additional information

Membership Type	Overseas Member

Title *
Surname *
Other Names *
Date of Birth *
Sex *	Male Female
Postal Address *
Contact Number - Home
Contact Number - Mobile *
E-Mail *
NIC/Passport Number *
Year of Graduation (MBBS/Basic Degree) *
Qualifications *
Sri Lanka Medical Council Registration No* *
Current Position / Designation *
Place of Work *

Below section is mandatory for Overseas Memberships
**The proposer and seconder should be members of the SLMA
**Name of Proposer
Mobile number of Proposer
Email of Proposer
**Name of Seconder
Mobile number of Seconder
Email of Seconder