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PUBLIC ADMINISTRATION ALUMNI ASSOCIATION
University of Chittagong, Bangladesh.
(Life Membership Form)'-
Recent photograph :
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Date :
lD No. :
Member Spouse
lnstructons: Please furnish relevant information in the corresponding blank spaces. Write N/A (Not applicable) if the
informaiion required in the blank space is not applicablb in y6ur case. Any false/fabriiated information or
concealment of fact may result in your permanent membership expulsion from this Association.
1. Full Name : (ln Block Letters)
In English
In Bangla
2. Details of Contact Address :
Present
Mailing Address
Permanent
Address
Phone/Cell Office Le
E-mail
Residence E-mail
3. Details of Educational Status :
Name of the Degree Batch Session Year of Exam Year of Passing
B.AJ BSS(Hons.)
IV.AJ MSS
Ph.D/M.Phil/Research
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PUBLTC ADMTNTSTRATTON ALUMNIASSOCTATTON sr_ ru".
University of Chittagong, Bangladesh.
lD No.
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Member's copy :
Mr./Mrs./Ms.
has been registered as Life Member of this Association.
Gonvener Member Secretary Treasurer

2.
4. Personal Details :
Father's Name
Mother's Name
Marital Statirs
Erie of the Spouse
Date of Birth Self: Spouse:
Blood Group Self: Spouse:
No. of Children
Date of Wedding
5. Personal Occupational Status:
Occupation Service: Business:
Name of Organization
Address
Designation/Position
Phone/Cell Phone/
E-mail/Fax
6. Whether you are Member of any International Charity Organization.
7. Details of your achievement in any field that you would like to mention:
I , ..................... ...., do hereby declore, the informolion furnished obove ole kue ond
complele. I qlso declore thot I om ioining it sponloneously ond will comply wilh the rules ond
regulotions of lhis Alumni Associotion ond will provide full suppod ond qssistonce lo ony proglom oI
oclivity initioted by it.
Date : Signature of the Applicant