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Membership Application Form: Photograph With Attested

1. The document is a membership application form for an organization. It requests information such as the applicant's name, address, education history, professional experience, and references from current members. 2. The form collects personal details including family members' names, contact information, education qualifications, training programs attended, and professional experience history. 3. Upon review of the application, references, and recommendation, the membership committee will decide whether to admit the applicant and at what level of membership based on their qualifications.

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russel_cse_cuet
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45 views

Membership Application Form: Photograph With Attested

1. The document is a membership application form for an organization. It requests information such as the applicant's name, address, education history, professional experience, and references from current members. 2. The form collects personal details including family members' names, contact information, education qualifications, training programs attended, and professional experience history. 3. Upon review of the application, references, and recommendation, the membership committee will decide whether to admit the applicant and at what level of membership based on their qualifications.

Uploaded by

russel_cse_cuet
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Photograph

With attested
Membership Application Form (2 copies 35mmX35mm)

1. Apply For The Fellow Member Associate Graduate


Member Member Member
2. Applicant’s
Name*
3. Father’s Name
4. Mother’s
Name
5. Spouse Name

6. Designation
7. Organization

8. Mailing
Address
(Detail)

Post
Code :
Phone Number Work Place : Residenc
e:
Fax Number Mobile :
E Mail # URL :

9. Permanent District : Upazila : 10.


Address Nationality
Post Office : Village : 11. Blood
Group :
Road # : Block # : 12. Birth
Date :
House # : Post Code : Sex : M F

13. Academic Carrier ( Record from last achievement )


Qualification/ Board / Year Score / Subject/Gr
Institution
Degree University of Class oup
Passin

14. Training Obtained ( Record from last achievement ; Use extra page if necessary )
Durati Training
Training Institute With Country Name of Topic/Course on Year
(Week

* Name - First Name/Middle Name/Last Name


Page # 02

15. Professional Records ( From present to previous ; use extra page if necessary )
Period (DD/MM/YYYY)
Name of Organization Designation
From To

16. Research Paper Information (If Any) Publication Information


(If Any)

17. Membership No. ( If any ) - Subcription paid up to ( Year ) :

I do hereby certify that the above statement is true & correct.

Date : .............................................
Applicant’s Signature

On the basis of the statement given I recommended for the grade of membership applied for……
18. Nomination :
Description Proposer Seconder - I Seconder - II
Name ( In block
letter )
& Membership
Number

Signature & Date

For Official Use

This Applicant is admitted for _______________ under clause


_______________________of__________________________

Convenor Member
Member Secretary

As per recommendation of Membership Board the applicant is awarded for __________________ in the
meeting of the management committee held on___________________ and the case has been recorded as
under:
Membership No. _____________________ Date of Enrolment _____________________ Receipt No.
Date:
Office Secretary

Certificate No. Date of Issue......................................................

Date :
Signature of the Secretary General

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