Membership Form
Cycling is not only a great activity to enjoy the fresh air, it also helps you stay away from harmful social influences such as drugs and addictions to online games. At BARISHAL CYCLISTS we practice cycling as a training and refreshment session so that we can explore and stay closer to nature. ☘️
Sign in to Google to save your progress. Learn more
Email *
Name (In English) *
Captionless Image
Name (In Bengali) *
Captionless Image
Father's Name *
Captionless Image
Mother's Name *
Captionless Image
Blood Group *
Captionless Image
Occupation  *
Captionless Image
Present Address *
Captionless Image
Permanent Address *
Captionless Image
Date of Birth *
Captionless Image
MM
/
DD
/
YYYY
Birth Registration/NID Number *
Captionless Image
Mobile Number *
Captionless Image
Facebook ID (Use Permalink) *
Captionless Image
Emergency Contact (Mention Relationship) *
Captionless Image
    Thank You for Joining With Us
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy