BIDE DIABETES CARE UPDATE 
Online Certificate Course
Registration Form

Question Title

* 1. Full Name:

Question Title

* 2. Institution:

Question Title

* 3. Current residential address:

Question Title

* 4. PMDC Registration No:

Question Title

* 5. CNIC No:

Question Title

* 6. Phone (Cell):

Question Title

* 7. Email ID:

Question Title

* 8. Bank Deposit Slip No / Bide Receipt slip No:

Question Title

* 9. Please note that your registration is not complete unless you pay the registration fee and submit scanned copy of bank deposit slip / Receipt of BIDE. 
     Course Fee is Rs.20,000/=
     Account Detail: Soneri Bank
     Head of  Account: Baqai Institute of Diabetology and Endocrinology
    Account No.: 02012136916

Question Title

* 10. Please indicate below if you have submitted the scanned copies of the required documents and photograph to BIDE via email (bdcu2016@gmail.com).

T