Membership Application Form

□ Yes, I am between the ages of 21 and 39 and want to become a member. Passport Size

OFFICE USE ONLY

Name of the LOM:
Application # Photo
Application Date:

Name:
Sex: □ Male □ Female Date of birth: dd / mm / yyyy Blood Group:
Company Name:
Job Title:
Work Address:
Phone: Fax:
Email:
URL:
Business Classification: (Please check the box according to your business type)
□ Accounting / Auditing □ Advertising / Promotion □ Construction / Engineering / Building □ Supply /
Renovation
□ Cafe / Restaurant / Hotel □ Entertainment □ Education / Educational Supply □ Finance /
Banking / Exchange □ Manufacturer □ Government / Civil Servant □ Information
Technology □ Medical / Laboratory □ Trading □
Service / Insurance □ Legal □ Travel / Transportation □ Other (please specify)

Education Qualification:
Home Address:
Phone: Fax:
Mobile:
Marital Status: □ Single □ Married Wedding Anniversary:

Introduced by Applicant

Name, Signature & Date Signature & Date

Personal Interest Information: (Please check the box according to your interest)
Individual Area of Opportunity
□ Personal Development □ Meetings
□ Trainer □ Training
□ Membership Growth & Extension
JCI Major Emphasis Community
Theme Development
Economic Affairs Children & Youth
Governmental & Civil

Chapter
International Affairs & Twinning
Relations
Awards

Records
Finance
Marketing & Public Relations
Strategic Planning
Chamber of Commerce
Business Affairs Partnership

OFFICE USE ONLY

Membership Approval By Membership Approval By
LOM NOM

Signature & Signature &

Date Date
Membership ID #

Fill-up the Membership Application Form with one copy passport size
photo
Submit your Membership Application Form to any of the Chapter’s
Secretary General

Community Area of Opportunity

• After getting the approval from the Chapter Membership Development Committee your
Membership Application Form will be forwarded to National Membership Development
Committee for further approval
• Again after approve from National Membership Development Committee and National
Governing Body (NGB), you will be awarded the JCI Membership at the following Chapter’s
Monthly General Meeting (MGM) after paying the JCI Bangladesh dues
• JOIN JCI Bangladesh, be a Jaycees