DLP BADAS
Certificate on Diabetology
Diabetic Association of Bangladesh
Shahbagh, Dhaka- 1000, Bangladesh
Registration Form
1. Student's Name
*
2. NID No
*
3. Father / Mother / Spouse Name
*
Select Relation
Father's Name
Mother's Name
Spouse's Name
5. WhatsApp No
*
4. Present Address
*
6. Emergency No
*
7. Email
*
8. Working in BADAS / Not Working BADAS
*
Working in BADAS
Not Working in BADAS
9. BMDC No
*
BMDC ID Type
*
Permanent
Temporary
Name of Institute
*
Select Institute
Affiliated Association
BIRDEM
NHN
BIHS
ICHRI
Others
Name of Association
*
10. Image of BMDC Certificate (less than 200KB)
*
11. MBBS (Passing Year)
*
12. Image of MBBS Certificate (less than 200KB)
*
13. SSC / Equivalent Passing Year
*
14. Image of SSC / Equivalent Certificate (less than 200KB)
*
15. Image of Candidate (size: 300*300)
*
16. Study Mode
*
Online
Offline
Online Session Time
*
Morning
Evening
Offline Location
*
Select Location
Dhaka
Chattogram
Faridpur
Khulna
Sylhet
Rajshahi
Rangpur
Offline Session Time
*
Morning
Evening
Offline Session Time
*
Morning
17. Image of NID(Front) (less than 200KB)
*
18. Image of NID(Back) (less than 200KB)
*
