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
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)
