Dhaka University English Language Alumni Association (DUELAA)

Membership Form
Attach a passport
Personal Information: size photograph

Name: Gazi Mohammad Shakil Imtiaz Fahad

Session: 2016-17

Present Address: Rd 1, Dendabor, Savar, Dhaka 1344

Permanent Address: Musapur, Sandwip, Chattogram 4300

Contact Number: +8801778754100 Contact Number (2): +8801538189339

Date of Birth: August 9, 1999 Email: gazifahadbd@gmail.com

Blood Group: A+ (ve) National ID No.: 1955196793

Professional Information:

Designation: Student

Institution University of Dhaka

Address of the Institution: Nilkhet Rd, Dhaka 1000

Annual Membership for 20…………….../ Lifetime Membership / Patron (Use tick mark)
Received Amount: ……………………In words: ….…………………………………………………….

Membership No: (To be filled up by Office) ……………Received by (Sign and Date): ……………….

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Dhaka University English Language Alumni Association (DUELAA)

Membership Card
Attach a
stamp size
Name: ………………………………………………………..… Session: …………………. photograph

Present Address: ……………………………………………………………………………...

Contact Number: ………………………………….. National ID No.: ……………………………………

Annual Membership for 20…………….../ Lifetime Membership / Patron (Use tick mark)
Received Amount: ……………………In words: ….…………………………………………………….
Membership No: (To be filled up by Office) …………Received by (Sign and Date): ………………….