Baridhara Society

01317008001
01304005004

Baridhara Society

Baridhara Society Membership Application Form

1. Category of Membership: Life General Senior Associate Donor

2. Name:

3. Father's Name:

4. Mother's Name:

5. Spouse's Name:

6. Address In Baridhara:

7. Address outside Baridhara:

8. Nationality:

9. Occupation:

10. Blood Group:

11. Marital Status:

12. Date of Birth:

13. Date of Marriage:

14. Telephone:

15. Mobile:

16. E-mail:

16.Phone Work Place:

17. Children`s Name 1

Gender

Age

Children`s Name 2

Gender

Age

Children`s Name 3

Gender

Age

18. Contact Person (emergency case)

Relation

Mobile

17. Membership Fees:

Life Membership Fee Tk. 50,000.00 (One time)

General Membership Fee Tk.5000(Yearly)

Senior Membership Fee Tk. 25,000.00 (One time)

Associate Membership Fee Tk. 5,000.00 (Yearly)

18. Eligibility:

Applicant must be 21 years of age at the time of submitting the application.

Only the Life, General, and Senior Members will have voting rights in the AGM & EGM.