Photograph
 (Passport size)
BUET ALUMNI ASSOCIATION
House No. 11, Road No. 138, Gulshan, Dhaka-1212

Life Membership Application
       
  1.  Name *
 Title  Last Name First/Other Names
 
2.  Date of Birth
Day Month Year
Sex:    M    F                             Blood Group
 
  3.  Father's Name*  
  4.  Mother's Name  
  5.  Degree Earned From*
     
BUET EPUET AEC ASC Others
Graduating Year
Degree
Department / Institute
 
      *  
 
  6.  Present Position
(last position held)		  
  7.  Contact Address
Apartment / House No.:  Street / Road No.:
City: 
District/State:   Post Code: 
Country: 
 
  8.  Telephone*

Office: 

Residence:

Mobile:  Fax: 
 
  9.  E-mail*
  10.  Professional Information:: Briefly state specialty / expertise area & experience (optional)  
   
 
 
  11.  Membership Option*

Life Member (Tk. 2,000)
Associate Life Member** (Tk. 2,000)

 
    * Mandatory Fields.
    ** Applicable to those who have not received any degree from BUET/EPUET/AEC/ASE but are present or past members of faculty, syndicate or academic council.
  I hereby declare that, as a Life Member / Associate Member , I shall abide by the rules and regulations of the
Association and support the activities of the Association that will help achieve its objectives.