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BALKAN MEDICAL UNION

Founded in l932
www.balkanmedicalunion.com ; www.umbalk.org
Address: l, G. Clemenceau Street, 010295-Bucharest-ROMANIA
phone: +40-21-3l37857 phone /Fax: +40-21-3121570
e-mail: drcameliadiaconu@gmail.com, ph 0726 377 300

International Secretary General:


Dr. Camelia DIACONU (Romania)

REGISTRATION FORM FOR STUDENTS

Name, surname……………………………………………………………………..
Place and date of birth……………………………………………………………..
University …………………………………………………………………………..
Faculty, year of study……………………………………………………………....
Home address……………………………………………………………………….
CV (attached)………..

Please accept my registration as a member of Balkan Medical Union, starting with the
year……….
I am recommended by……………………………………………………………..

Date Signature

Please fill in this registration form and send it by email to


drcameliadiaconu@gmail.com, together with a photo.
There is no registration fee for students.

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