- Department of CME

REGISTRATION FORM

Basic Information

First Name:

Last Name:

Speciliaty:

Designation:

Qualification:

Institution:

Address:

City:

Country:

CNIC NO#:

LNH Employee No#:

Passport NO# (Optional):

PMDC Registration No#:

Email Address :

Phone No#:

Title of the activity :

Name of Organizer/Planner

Type of CME Activity :

In-Person

Payment details: Applicable Not Applicable

Payment Option:

Online / Bank Challan / Payorder

Name of Bank:

Challan/Draft No# :

Session Date: