THE BANGLADESH SOCIETY FOR BIOCHEMISTRY & MOLECULAR BIOLOGY

                                                (Membership Form)                             BSBMB

Website: http://www.bsbmb.org

(All applicants are subject to the approval of the executive council)

Personal Details:	Name (Capital Letter)……………………………………………………………………………….
			(Last Name)……………………………………(Other Names)………………………………..
………………………………………………………………………………………………………………………………………………………….Title:………………………………………………………………………………………………………………………………………………..
Academic Qualifications: ………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………
Present Occupation: ……………………………………………………………………………………………………………………….
Mailing Address:………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………
Fax:……………….Telephone:……………………………………………..Email:…………………………………………………..

Membership:		I wish to apply for membership of the Bangladesh Biochemical Society as: (Please tick appropriate box)

•	Ordinary Member	•	Life Member	
•	Student Member	•	Associate Member	

Subscription:		I agree to pay the membership fee and annual Subscription or life membership fee Tk……………………………………………………………………….

Declaration:		I declare that I shall abide by the rules and regulations of the society.
Signature of the applicant………………………………………………………………….
Date:……………………..

Nominating Members: This section should be completed by two members of the society to whom this applicant is known. I declare that the applicant is personally known to me and I propose/second that the applicant be considered for membership.

Signature			Name				Membership No.

Proposer…………………………………………………………………………………….
Second……………………………………………………………………………………...

The membership subscription either in cash or cheque along with the completed application form should be sent to the General Secretary of the Bangladesh Society for Biochemistry & Molecular Biology. The new member will be officially notified once the application for membership is approved by the executive council.

For Office Use Only

The membership application of Prof./Dr./Mr./Ms……………………………………………………..
has been found valid and is approved by the executive council on ……………………….
His membership No is …………………………………

President	General Secretary	

The Bangladesh Society for Biochemistry & Molecular Biology 	
The Bangladesh Society for Biochemistry & Molecular Biology 	

The Bangladesh Society for Biochemistry & Molecular Biology received with thanks from Prof./Dr./Mr./Ms…………………………………………………..Tk…………………
(…………………………………………………) only  as membership fee subject to approval of the executive council.

Date:……………………….				Received by:……………………