Membership Form [Any Muslims of Bangladeshi heritage in North America, who agrees with the aim and purpose of this organization, actively participates in its activities, and commits to abide with its rules and principles, can be a voting member by filling out the membership form and paying the dues determined by the Executive Committee of NABIC–Bylaws of NABIC] Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Spouse Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home #Cell #Email* Profession Membership Fees (Circle One)Choose Membership Type* Regular (Family $100/Single $50) Life ($1000) Regular:* Family (per year $100.00 ) Individual (per year $50.00) Product Name* Price: (*one fee for two separate voting members, husband and wife) Total $0.00 NABIC P.O. Box 770546 Memphis, TN 38177-0546
