হোপ অটিজম ওয়েলফেয়ার সোসাইটি জেনারেল কমিটি মেম্বারশীপ ফর্ম এই ফর্মটি পূরণ করুন এবং জমা দিনশিরোনাম Mr.Mrs.Ms.Othersছবি আপলোডঃ *একটি পাসপোর্ট সাইজ ছবি আপলোড করুন. সর্বোচ্চ আকার 1MB।নামঃ *পিতার নামঃ *মাতার নামঃ *চিঠি পাঠানোর ঠিকানা: Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryমোবাইল *ফোন: ওয়ার্কঃ Email: *পেশাঃ এনআইডি নম্বরঃ *পেশা: *NID: back side *Membership Level *General MemberLife MemberArea of Interest: Please 3 as appropriate. (May chose more than one option) 1. Take an Executive Role2. Society Publicity3. Help with fundraising4. Participate as a sub-committee5. Join as a sub-committee6. OthersI agree to abide by the rules and reguations of the Hope Autism welfare society. *YESPayment Details: 1. Membership Admission Fee: 100 Taka (one time playable) 2. General Membership Subscription: Taka 50 per month. ie. taka 600 per year. 3. Life Membership: Taka 50,000/- one time for life Cheque must be drawn in favour of Hope Autism welfare society ভেরিফিকেশনঃPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
