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For the Member of Cooperatives

X
Name of the Institution :
Name of the Course :
Course Starting Date :
Course Ending Date :
Name of the Participant :
Father's Name :
Mother's Name :
Date of Birth :
Mailing Address :
Contacts (Mobile/Email) :
Name of the Society* :
Reg. No. & Date :
Position :
Address of the society :
Upazilla* :
District* :
Captcha + = ? :

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