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BSTQM MEMBERSHIP APPLICATION FORM
1. Member
*
Life Member
Corporate
Foreign
Student
Photo
*
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:
Business
Govt. Service
Private Service
Consultant
Student
Self Employed
Other
11. Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Mobile/ 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 Proposer
Sign
*
Upload your sign (300*80px)
Membership Fees:
1) Life Membership: Tk. 10,000.00 2) Corporate Membership: Tk. 100,000.00 3) Foreign Member: USD 200 4) Membership Certificate: Tk. 100.00 5) Student Membership: Tk. 1000.00
Verification
Please enter any two digits
Example: 12
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please leave it blank
:
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