This form may be used for NEW members or by existing members as an UPDATE
This form is for use by physicians and dentists only. Please complete all fields

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Please mail the completed form along with payment to
 BIMDA Treasurer:
Attention: Dr. Subhash Rege, MDS
1045 Hwy A1A
Oceana Apartment #901
Satellite Beach, FL 32937
Phone: 321-779-0598
   Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Brevard Indo-American Medical & Dental Association (BIMDA)
BIMDA is a not-for-profit professional association of physicians and dentists, IRS code sec 501 (c) (6).
BIMDA is a member affiliate of AAPI - American Association of Physicians of Indian Origin.
Membership in BIMDA is open to all physicians & dentists in good professional standing.
Membership application is subject to review and acceptance.  All rights reserved by BIMDA.
BIMDA Federal Tax ID # 59-3576907
www.bimda.com
(Version: October 2017)