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Bangabandhu Sheikh Mujibur Rahman Maritime University Alumni Association (BSMRMUAA)
14/6-14/23, Mirpur-12, Pallabi, Dhaka-1216
E-mail: [email protected], Web: www.bsmrmu.edu.bd
MEMBERSHIP APPLICATION
1. Name (In English) (In Bengali)
2. Date of Birth Day Month Year Gender: M F Blood Group
3. Father’s Name 4. Mother’s Name 5. Spouse Name
6. Degree Earned SL Year of Graduation Degree Department/Faculty University/Institute 1.
2.
7. Present Position (if retd. last position) 8. Contact Address
9. Telephone Office Residence
Mobile Fax
10. Email 11. Professional
Information:
Briefly state specialty/expertise area & experience (optional)
12. Membership Type Member Life Member Associate Member Life Associate Member Professional Member Life Professional Member Patron
13. Membership Fee Paid Unpaid
I hereby declare that, as a Life Member/Associate Life Member, I shall abide by the rules and regulations of the Association and support all activities of the Association that will help achieve its objective.
Signature Date
Photograph
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FOR OFFICIAL USE ONLY Membership Number
1. Membership Granted/Not Granted 2. Forwarded to EC for Approval
3. Forwarded to Academic Council BSMRMU
Secretary General BSMRMUAA Membership Granted/Not Granted by EC/Academic Council via
………..
Secretary General BSMRMUAA
