Registration – Barishal CIty & Sadar Socity, USA

Membership Application

Fill out the form below to apply for association membership.

Personal Information

First Name *

Middle Name

Last Name *

Email Address *

USA Phone Number *

Password *

Note: Minimum 8 characters, at least 1 uppercase letter and 1 number.

Confirm Password *

USA Address Details

Street Address

City *

State *

Zip Code

Bangladesh Address Details

Bangladesh Address

Bangladesh Phone Number

+880

Media Attachments

Applicant Picture * (JPG/PNG/GIF/WebP, max 5MB)

Applicant Signature (Optional)

I, the undersigned do hereby agreed to abide by the laws & regulations of the Barisal City & Sadar Society USA and state that the above information given in the membership application is correct and true to the best of my knowledge.

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