Member Registration Form - Diploma in Electro-Medical Engineer's Association

Member Registration Form

Type of Member *

Personal Information

Name in English *

Name in Bangla *

Father's Name *

Mother's Name *

Spouse Name

Date of Birth *

National ID No *

Mobile No *

Email *

Blood Group *

Religion *

Sex *

Address

Permanent Address *

Present Address *

Educational Qualification

Name of Exam *

Institution *

Board / University *

Year of Passing *

Department / Technology

Division / Class

Professional Service Record

Name of Dept. / Org. with Address

Designation

Date of Joining

Status

Required Attachments

Photo *

NID Photo

Payment Details

Member Fees : Taka

Bank Name : bKash
Account No. : 01720-363919
Account Type : Personal (Send Money)

Bank Name : Nagad
Account No. : 01720-363919
Account Type : Personal (Send Money)

Bank Name : Dutch Bangla Bank PLC
Account Name : Charfasson Upazila Samity Dhaka
Account No. : 1911570159588
Account Type : Current Account
Branch Name : Bijoy Nagar Branch, Dhaka

Bank Name : Cash

Paid Amount *

Payment Method *

Transaction ID *

Password

[Note - The boxes marked "*" must be filled.]