Alumni Registration Form

Australia Alumni Association Bangladesh (AAAB) MEMBERSHIP APPLICATION FORM

(*) Marked Field is Mandatory.

Full Name with Title:(*)
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Date of Birth:
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Gender:
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Mailing Address:
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Mobile Phone:(*)
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Other Phone:
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Email Address:(*)
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Award/ Scholarship Name:(*)
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Year Degree Completed :(*)
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Australian University:(*)
This field is required please type the name of the Australian University you have studied.

Course Name:
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Current Employer and Address:
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Current Position:
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Membership fee payment (please include details as appropriate):
[A membership fee Tk100 for annual membership of Tk1000 for lifetime membership can be paid in cash at the Australia Awards Office or by bKash to 01700834274. The deadline for submitting this form AND payment is 6 May 2016. ]

Amount (in numbers and words)
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Mode of payment (please tick)
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bKash number, if sent by bKash
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By submitting this Membership Form:
I agree to abide by the rules of the Association including any agreed membership fee. I consent to my personal details being shared with other members of the Association, the Australia Awards Office and other parties associated with the Australia Awards for the purposes of the management and promotion of the Australia Awards. I consent to having my name, photograph and other personal details published in any promotional materials produced by or for the Association such as website, Facebook page and/or newsletters.

(*)
If you agree with the condition above Please check the box, Yes I agree to join the Australia Alumni Association Bangladesh (AAAB)

Captcha :(*)
Captcha :
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