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MEMBERS’ REGISTRATION FORM

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*Name:

*Life Number:

Father’s Name:

Mother’s Name:

*Date of Birth :

Sex:

Male Female

NID:

Marital Status:

Married Unmarried

Spouse name :

Blood Group :

*Email Address:

Alternate Email Address:

*Password:

*Confirmation of Password:

Address

Bangladesh Society of Neurosurgeons, Room No. 529. Dept. Of Neurosurgery Bangabandhu Sheikh Mujib Medical University Shahbag, Dhaka - 1000, Bangladesh

Tel:

+88 2-9137292

Fax: + 88 2-9137292

Email

bdneurosurgeons@yahoo.com,
bsnsbd98@gmail.com