Bangladesh Unity Federation of Los Angeles (BUFLA)

Membership Application Form

Name of the Organization  _________________________________________________

Address  _______________________________________________________________

Phone: ___________________    E-Mail:                              Website:

Type of Organization: (Circle any):  

Cultural    Social    Political     Religious    Charitable   Business    Educational   Other

Date of Formation of the Organization   ____________________________

Names of four EC members or officers of the Organization:

1._________________________________       2. _______________________________

3._________________________________       4. _______________________________

Category of the Organization (Circle any): 

Non-Profit       For-Profit        Mutual-Benefit           Public-Benefit             Other

Mention some of the activities in the past:   ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please use separate paper if needed.

Comments about BUFLA: ________________________________________________________________________________________________________________________________________________

To the best of my knowledge, the information mentioned above are true and correct.

Signature of the President/Lead-Person/Secretary

-----------------------------------------                                 -------------------------------------------

Print Name:                                                                 Date

Title:                                                               

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Endorsed by the Secretary of BUFLA           Approved by the President of BUFLA         

Please fill out the form, sign it, and mail it with a check of $100 as membership fee  (payable to BUFLA).

The mailing address is: BUFLA,  PO Box 10325, Westminster, CA 92685.