United Nations Women's Association in Bangladesh

Please Check One:

membership  form

For Official Use Only:

� Renewing Member

Full Member  � 

� New Member

2005 - 2006

Associate Member  � 

 Name:  (Ms./ Mrs. / Dr.)

(First)

(Middle)

(Last)

 Address: (Flat)

(Apt#, House) 

(Road)

(Area of Dhaka)

 Country of Nationality:

 Organization:

 Work? (check one)   � Full-time         �Part-time

 Job Title:

 Telephone: (home)

 (work)

 Mobile:

 Fax:

 E-mail:

 Spouse Name: 

 Circle:  Mr.  /  Dr. /  H.E.

(First)

(Middle)

(Last)

 Spouse Nationality:

 Organization:

 Spouse Job title: 

 Date of arrival in Bangladesh:

 Expected date of departure:

For your application to be considered favourably, you have to check at least one.

Please check the following UNWA activities that you would like to participate in this year: 

(select at least one)

Applicants have to actively participate in UNWA activities to be eligible.

� Executive Board

�  Membership

�  Host meeting

�  Exhibitions

� Welfare

�  Hospitality

�  Host tea/lunch

�  Speaker at meeting

� Activities

� Finance

�  Cultural shows

�  Lead a Study Group

�  Publications

�  Programme 

�   UN Ball Committee

�  Website

�  WOMUN delivery

� Other:

 Signature: 

 Today's date:

Please print out this form, fill out clearly, and submit with your payment
(a cheque for Tk.1000 made out to UNWA-Bangladesh) at the General Meeting or Newcomers Coffee Morning.
Deadline for Renewing Membership: June General Meeting
Deadline for new members: December General Meeting 

membership (New or renewal) is not automatic, allow two weeks for the Executive board to approve applications.