The Burmese Medical Association of North America

Connecting Burmese Medical Professionals Across the United States and Canada

Donations to Humanitarian & Educational Fund

 

Title:   please circle one: Male Female
First Name:  

DOB (mm/dd/yyyy):___/___/______
Middle Name(s):  
Last Name:  

 
Year Graduated:  
Degree Conferred:  
Specialty:  
Address:  

 
City:  
State, Zip/Postal Code:  
Country:  
Telephone #1:   Ext:  
Telephone #2:   Ext:  
Fax:  
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Donations to BMA-NA's Humanitarian & Educational Fund
(please print, fill & mail the form with check)

BMA-NA's Humanitarian & Educational Fund is Tax Deductable as Charitable Donations. 

Donors who are interested in expanding and furthering our mission, write your checks payable to BMA-NA, HE Fund

In the "comment" part of the check you may write in - Burma Medical Library Project - if that is what you wish.

Mail to:           Sein Aung, MD
                        Treasurer, BMANA
                        P.O. Box 20052
                        Baltimore, MD 21284

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