Georgian Society for Cervical Pathology and Colposcopy (GSCPC)
Application form for membership
First name		Last name
Profession		Certificate #
Working place:
Position		Address
Telephone		E-mail
Home address
Telephone		E-mail
Membership of other medical societies or associations
Have you completed any special training course in Cervical Pathology and Colposcopy?			Yes No
If yes, what exactly?

The annual membership fee is 25 (twenty five) GL.
The number of account is 3608106563, Bank Republic (central office), #2, Gr. Abashidze Str, Tbilisi, Georgia.