Become Riverine People

ID NO (By Office)………………………….

Primary Membership Form

Name (In Bangla):

Name (In English Block Letter):

Name of parents:

Gender:

Date of Birth:

Contact Number:

E-mail:

Phone:

WhatsApp:

Facebook:

Twitter:

Present Address:

Permanent Address:

Primary Area of Interest

Movement:

Campaign

Research

Advocacy

Rationale for Joining Riverine People: ……………………………………………………………………………..

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Name and Position of the Endorser:

River of Affiliation:

Signature of the Applicant                                                              

Signature of the Endorser