Online Membership Renewal Form

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This online form is ONLY for Membership Renewal. For new membership applications, please visit www.duaane.org and click on the "Print Membership Form PDF" under the Membership menu.

DUAANE is a not for profit corporation registered in Massachusetts. All information is voluntary and DUAANE is no way responsible for misrepresentation in any form.

By signing or transmitting this form electronically one acknowledges that the veracity/accuracy of the above information could be verified by DUAANE in a way it deems fit and that he/she agrees to abide by the articles and memorandum of DUAANE and any other rules of the organization there after. In the event the information provided in this form is found to be untrue, DUAANE reserves full right to cancel the membership of the applicant.

Important: Please remember to send in your membership payment via check as per instructions on the www.duaane.org website. Without payment, your membership application is incomplete and not valid. The address to send the membership payment by check is given on our website www.duaane.org in the membership page.

For signature purposes, electronically submitting this form using your own full name and checking the box "I Agree" in this form will be considered the same as your digital signature.

The date entered below should be put in the following form: mm/dd/yyyy

Membership Application Type *

Renewal (only for existing DUAANE members) : $20.00 for a 1 year membership term

Lifetime Membership (for existing DUAANE members): $500.00 one-time payment for lifelong membership with DUAANE

Acknowledge your intent to pay for your membership *

Your membership application will not be valid until your payment is received by DUAANE. Please make your check/money order payable to DUAANE and send it to the following address: DUAANE, C/O Dr. M. A. Hakim, 8 Rolfe Road, Lexington, MA 02420

I will send the required payment by mail to the official address as listed above (see also www.DUAANE.org)

Required

First Name (and Middle Initial) *

Last Name *

Department/Subject Studied *

Residential Hall (resident or attached to): *

Name of Degree Obtained: *

Date Degree Obtained (mm/dd/yyyy): *

YYYY

Graduation Year (YYYY) *

If graduate from Dhaka University Affiliated College - Name of Affiliated Institute or College

Present Address *

Phone number (Mobile) *

Phone number (Landline)

Electronic Signature. BY CHECKING THE “I AGREE” CHECK BOX DISPLAYED BELOW AS PART OF THE DUAANE MEMBERSHIP REGISTRATION PROCESS, YOU AGREE THAT TYPING ELECTRONICALLY YOUR FULL NAME IN THE TEXT BOX BELOW IS YOUR OFFICIAL DIGITAL/ELECTRONIC SIGNATURE AND IT IS THE LEGAL EQUIVALENT OF YOUR HANDWRITTEN SIGNATURE. *

I AGREE

Required

Your Full Legal Name *

This shall be considered as your digital/electronic signature and is equivalent to your handwritten signature.

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