Registration Form for the Membership of mltap



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M
EDICAL LAB. TECHNOLOGISTS ASSOCIATION OF PAKISTAN (MLTAP)

CERTIFYING EXCELLENCE IN DIAGNOSTIC & RESEARCH



HEAD OFFICE: House # B-24, Rawal Dam Colony, Islamabad- 44000, Pakistan. Cell:+923005293705
REGIONAL OFFICE: Technologist House, House # 03 Main Street, Qazafi Colony Near Uniliver Pul, Rahim Yar Khan - 64200, Punjab, Pakistan. Tel: +92-68-5874610 Cell: +92-333-5216610

Web: www.mltap.com.pk e-mail: info@mltap.com.pk


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Registration Form for the Membership of MLTAP

Name:___________________________________________________________
Father’s Name: ____________________________________________________
D.O.B: __________________________________________________________
N.I.C: ___________________________________________________________
Domicile: ________________________________________________________
Address: _________________________________________________________
E-mail: __________________________________________________________
Ph. ______________ Mob. ________________ Fax: ____________________
Qualification: _____________________________________________________
Institute: _________________________________________________________
Designation: ______________________________________________________
Organization: _____________________________________________________
Ph. ___________________ Fax: _____________________________________
Medical Technologist: By Designation / By Qualification (Select One)
Registration Type Applied for: 5 years / Associate / Student (Select One)
For Official Use Only

I.D. __________________ Date: _______________ Fees: Rs.__________/-


Reg. No. ______________

Admin Officer


DICIPLINE




  1. Do not misuse the name of association at any forum.

  2. Abide by all the decisions taken by the executive body.

  3. Do not take part in any illegal activities being a member of the association.

  4. Make it compulsory to attend all the meetings called by the association.

  5. It is mandatory to maintain and send monthly activities & progress report to the head office of the association.


UNDERTAKING BY THE MEMBER AT THE TIME OF REGISTRATION


I pledge to confine my activities to the academic, healthy & positive pursuits as a member and will not indulge in any illegal activities sponsored or promoted by the political parties and association working in or outside the country directly or indirectly.

I fully understand that in case of breaking my pledge, I shall be liable to be expelled and cancelled my registration from the association.

Signature of the Member Counter signed by;

President / General Secretary

Verified by Association. (Representative, MLTAP)


Reference

Name: ________________________________


Address: ______________________________
_____________________________________
N.I.C No. _____________________________

Signature: _____________________________


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