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Membership Application

Complete the official Bangladesh Society of Cardiovascular Intervention membership form online. Information and documents are securely submitted to the Secretariat.

Bangladesh Society of Cardiovascular Intervention

Application for Membership

1Personal

2Professional

3Referees

4Documents

General MembershipBDT 2,000

Life MembershipBDT 10,000

1. Applicant Information

Name in Bangla

Type phonetic English (e.g. mohammad rahim); it converts to Bangla as you type.

Name in English *

Applicant Photo *

Recent photo, max 2 MB

Father's Name *

Mother's Name *

Date of Birth *

Present Designation *

Institution / Hospital *

Mailing Address *

Phone

Fax

Email (Login ID) *

Password *Minimum 12 characters. Use a unique password.

Confirm Password *

Nationality *

NID / Passport Number *

Medical Society Membership / Fellowship

2. Academic Qualifications

Swipe horizontally to complete the table.

Degree	Year	Name of Institution	Country

3. Training in Cardiology

Institution	Country	From	To	Duration

4. Practical Experience

Procedure	Done Independently	Training Place	From	To	Duration

5. Publications as Primary Author

Journal	Year	Title	Co-author

6. Recommendation of Two Referees (Trainers)

Referee 1 Name *

Membership Number

Institution / Hospital *

Referee 2 Name *

Membership Number

Institution / Hospital *

7. Enclosures & Payment Reference

NID / Passport Copy *PDF/JPG/PNG, max 5 MB

Academic Certificates *

Cardiology Training Certificate

BMDC Certificate

Payment method (optional)

Payment transaction referenceIf payment was already made, submit both method and transaction reference.

I solemnly declare that the information supplied is true and I will abide by the Constitution, rules and regulations of BSCI. Incomplete or inaccurate applications may be rejected.

Membership Application

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