HOPE AUTISM WELFARE SOCIETY GENERAL COMMITTEE MEMBERSHIP FORM Please Complete this form and submitTitle (please 3 as appropriate) Mr.Mrs.Ms.OthersPhoto Upload: *Please upload a Passport size photograph. Max size 1MB.Name: *Father's Name: *Mother's Name: *Mailing Address: রাস্তার ঠিকানাApt, Suite, Bldg. (ঐচ্ছিক)শহররাজ্য/প্রদেশ/অঞ্চলপোস্টকোড / জিপকোডAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua 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 SamoaYemenZambiaZimbabweদেশMobile: *Phone: Work: Email: *Occupation: NID Number: *NID: Front side *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 VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
