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Membership Registration – Foreign
$
250.00
Title
*
Dr.
Prof.
Mr.
Ms.
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
*
Membership Registration - Foreign quantity
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SKU:
102
Category:
Uncategorized
Additional information
Additional information
Membership Type
Overseas Member
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