BNA, Central Executive Council

MemberShip Form

Branch Type:

Division:

Branch:

Member type: *

Name: *

Father's Name: *

Mother's Name: *

Date of birth: *

Write Month/Day/Year or, Tap on Datepicker

Religion: *

Blood group: *

Gender: *

National ID. No. *

Passport No.

BNMC Register No. *

Employee:

Office name:

Office Designation:

Office phone:

Spouse name:

Spouse profession:

No of children:

Permanent Address

Division: *

Post Code: *

Address: *

Present Address

Division: *

Post Code: *

Address: *

Please fill up at least two of your education degree.

Name of the Degree

Institution

Board/University

Passing Year

Email: *

Mobile number: *

Password: *

Password confirmation: *

Upload Profile Image

Photo should be around 300 X 300 (width X height) and file size not more than 1MB

Upload Singnature

Signature Should be around 300 X 80 (width X height) and file size not more than 600kb

I hereby declare that the particulars given above are correct and I am assuring that if at any time any statement given above is found to be incorrect, my membership, of granted, will be liable to be cancelled and the fee paid by me will be forfeited. I do hereby solemnly pledge my full confidence in the constitution of the Bangladesh Nurses Association and agree to abide by its rules and regulations Any decision of the General Body/Central Executive Council shall be binding on me. I pledge NOT to involve myself in any way which may dishonor the prestige of the association and its members.

Membership Fees: Yearly ৳1000/- , Lifetime ৳5000/-
For Diploma Student ৳300/- For BSc Student ৳500/-

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