Life Time Membership_PAAA

Feb 28, 20110 likes112 views

This document is a life membership form for the Public Administration Alumni Association of the University of Chittagong, Bangladesh. It requests information such as name, contact details, educational background, personal details, occupation, and a declaration agreeing to comply with the association's rules. The form notifies that providing false information could result in expulsion from membership. It also provides space for details of any achievements or international charity involvement to be mentioned.

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PUBLIC ADMINISTRATION ALUMNI ASSOCIATION
University of Chittagong, Bangladesh.
(Life Membership Form)'-

Recent photograph :
9tto'il4
Date :

lD No. :

Member Spouse
lnstructons: Please furnish relevant information in the corresponding blank spaces. Write N/A (Not applicable) if the
informaiion required in the blank space is not applicablb in y6ur case. Any false/fabriiated information or
concealment of fact may result in your permanent membership expulsion from this Association.

1. Full Name : (ln Block Letters)
In English

In Bangla

2. Details of Contact Address :
Present
Mailing Address
Permanent
Address

Phone/Cell Office Le
E-mail
Residence E-mail

3. Details of Educational Status :
Name of the Degree Batch Session Year of Exam Year of Passing

B.AJ BSS(Hons.)

IV.AJ MSS

Ph.D/M.Phil/Research

M
wry
PUBLTC ADMTNTSTRATTON ALUMNIASSOCTATTON sr_ ru".
University of Chittagong, Bangladesh.
lD No.
,l I4
Member's copy :

Mr./Mrs./Ms.
has been registered as Life Member of this Association.

Gonvener Member Secretary Treasurer

4. Personal Details :
Father's Name

Mother's Name
Marital Statirs

Erie of the Spouse
Date of Birth Self: Spouse:

Blood Group Self: Spouse:

No. of Children

Date of Wedding

5. Personal Occupational Status:
Occupation Service: Business:

Name of Organization

Address

Designation/Position

Phone/Cell Phone/
E-mail/Fax

6. Whether you are Member of any International Charity Organization.

7. Details of your achievement in any field that you would like to mention:

I , ..................... ...., do hereby declore, the informolion furnished obove ole kue ond
complele. I qlso declore thot I om ioining it sponloneously ond will comply wilh the rules ond
regulotions of lhis Alumni Associotion ond will provide full suppod ond qssistonce lo ony proglom oI
oclivity initioted by it.

Date : Signature of the Applicant

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Life Time Membership_PAAA

1. ,'- M w PUBLIC ADMINISTRATION ALUMNI ASSOCIATION University of Chittagong, Bangladesh. (Life Membership Form)'- Recent photograph : 9tto'il4 Date : lD No. : Member Spouse lnstructons: Please furnish relevant information in the corresponding blank spaces. Write N/A (Not applicable) if the informaiion required in the blank space is not applicablb in y6ur case. Any false/fabriiated information or concealment of fact may result in your permanent membership expulsion from this Association. 1. Full Name : (ln Block Letters) In English In Bangla 2. Details of Contact Address : Present Mailing Address Permanent Address Phone/Cell Office Le E-mail Residence E-mail 3. Details of Educational Status : Name of the Degree Batch Session Year of Exam Year of Passing B.AJ BSS(Hons.) IV.AJ MSS Ph.D/M.Phil/Research M wry PUBLTC ADMTNTSTRATTON ALUMNIASSOCTATTON sr_ ru". University of Chittagong, Bangladesh. lD No. ,l I4 Member's copy : Mr./Mrs./Ms. has been registered as Life Member of this Association. Gonvener Member Secretary Treasurer

2. 4. Personal Details : Father's Name Mother's Name Marital Statirs Erie of the Spouse Date of Birth Self: Spouse: Blood Group Self: Spouse: No. of Children Date of Wedding 5. Personal Occupational Status: Occupation Service: Business: Name of Organization Address Designation/Position Phone/Cell Phone/ E-mail/Fax 6. Whether you are Member of any International Charity Organization. 7. Details of your achievement in any field that you would like to mention: I , ..................... ...., do hereby declore, the informolion furnished obove ole kue ond complele. I qlso declore thot I om ioining it sponloneously ond will comply wilh the rules ond regulotions of lhis Alumni Associotion ond will provide full suppod ond qssistonce lo ony proglom oI oclivity initioted by it. Date : Signature of the Applicant

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Life Time Membership_PAAA

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Life Time Membership_PAAA