BSTQM MEMBERSHIP APPLICATION FORM1. Member *Life MemberCorporateForeignStudentPhoto *Upload Passport Size Photo (413x531 pixels)2. Name of Applicant / Corporate Body *(In capital letters)3. Name in Bangla Download Avro (https://www.omicronlab.com/avro-keyboard.html)4. Name of employer (other than corporate body) : Employer’s address: 5. Name of educational institution (for student) : 6. Name of nominated key persons with designation (For corporate Member) : *7. Father’s Name: (Nominated key person in case of Corporate members)Mother’s Name 8. Date of Birth: *(Date of incorporation in case of organization)9. Details of Educational Qualification (For individual member): *10. Profession: BusinessGovt. ServicePrivate ServiceConsultantStudentSelf EmployedOther 11. Address *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 SamoaYemenZambiaZimbabweCountryMobile/ Phone *Email *Business / Office with designation (Name of the organization: Designation: Address: Phone: e-mail:)12. Detailed experience / areas of business involved in: 13. Membership of other organizations (if any): Name of the organizations 14. Special contribution to BSTQM, if you like to mention 15. Optional Information:Name as in Passport: Passport No: Date and place of issue: Expiry Date Address as in passport (Present & Permanent)National ID No: Names of children with mob: Name of Spouse with mob: Wedding Date Blood Group Alternate e-mail Alternate Mobile Confirmation: I/We would like to be a member of BSTQM. I/we agree to abide by the Constitution, Rules & Regulations, Policy and EC Decision of BSTQM and will make endeavor for the “Continual Improvement” of BSTQM. I/We declare that the information provided above is correct.16. Proposer: Name : BSTQM Membership No: Address of the ProposerSign *Upload your sign (300*80px)Membership Fees: Membership Fees: 1) Life Member: Tk. 10,000.00 (Taka Ten Thousand only) 2) Foreign Member: USD200 (US$ Two Hundred only) 3) Student Member: Tk. 1000.00 (Taka One Thousand only) 4) Membership Certificate: Tk. 500.00 (Taka Five Hundred only) 5) Institutional/Corporate Membership Fee: BDT 300,000/- or USD 4000 VerificationPlease enter any two digitsExample: 12This box is for spam protection - <strong>please leave it blank</strong>: BSTQM_Membership Form Corporate Membership Form_BSTQM