Member Registration

Name(In block letters)  :

Present Address           :

Telephone                      :

Permanent Address     :

Telephone                     :

Qualification Institution Year
1.
2.
3.
4.

Present Position Held                                            :

Any Difficulty Encountered in Present Position :

Any Other Information in favour                           :


Proposed By :
Name :

Address :

Seconded By :
Name :

Address :


Taka* :

Please select anyone* :


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