Brevard Indo-American Medical and Dental Association

Membership Application

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

Download Form

Please mail the completed form along with payment to
 BIMDA Treasurer:
Attention: Dr. Subhash Rege, MDS
406 Lanternback Island Drive
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
(Version: October 2017)