Register -

Bagladesh Association of Gold Coast (BAGC) Inc. Membership Form

Personal Details

Green Members : Anyone of Bangladeshi heritage residing in the greater Gold Coast area.

Red Members : Anyone of Bangladeshi heritage residing outside of the greater Gold Coast area

Yellow Members : Anyone living in Australia of non-Bangladeshi heritage.

First Name*

Last Name*

E-mail Address*

Password*

Confirm Password*

Mobile Number*

Birth Date*

Gender*

MaleFemale

Profession*

Company

Address*

E-mail Address*

Spouse Info (If Any)

Spouse Name

Children Info (If Any):

Children 1 Name

Children 1 Age

Children 2 Name

Children 2 Age

Children 3 Name

Children 3 Age

Children 4 Name

Children 4 Age

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