PATUAKHALI SCIENCE & TECHNOLOGY UNIVERSITY ALUMNI ASSOCIATION

(PSTUAA)
Attach 2 copies
passport & 1 stamp
size photo

Membership Application Form

1. Name

: .................................................................................................

2. Fathers /Husbands Name : .................................................................................................

3. Mothers Name

: .................................................................................................

4. Present Address

: .................................................................................................

............................................................................................................................................................
Phone No: Office:

Res:

Mobile No:

E-mail:

Fax:

5. Permanent/Home Address: .....

................................................................................................................. ....... ...................................
6. Date of Birth

Age (Application date):

7. National ID

Passport No.

8. Academic Details :
Name of Degree

Year of Passing

Board/Institution

University

9. Present Position/Occupation :
10. Last Position held (if retd.)

.........................................................

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Signature of Recommender (with Date)

Signature of the Applicant (with Date)

Approved by

________________________

___________________________

Secretary General

President

NB: Enrollment fee-BDT 100, & Life Membership Fee: BDT 2000.00