Become a Member - Cadet College Club of North America

Membership Application

User Name:*

Username

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Password:*

Enter a strong password

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Repeat password:*

Repeat password

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Full Name:*

Your Full Name (FirstName MiddleName LastName)

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Date of Birth:*

Format: DD/MM

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Phone # (Mobile):*

Phone/ (Mobile):*

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Phone # (Home)*

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Alternate Email Address:*

Alternate Email Address:

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Education Details:*

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Current Profession or Occupation:*

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Home Address (City):*

Home Address (City)

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Home Address (State): *

Home Address (State): (US or Canada)

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Mailing Address: (If different from above)*

Street Address, City, State, Zip

Mailing Address: Street Address, City, State, Zip*

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Reference Contact Name (Any Ex-Cadet or CCCNA Member):*

Format: FirstName MiddleName LastName

Reference Contact Name (Any Ex-Cadet or CCCNA Member):

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Reference Contact Phone# (Any Ex-Cadet or CCCNA Member): *

Reference Contact Phone

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Membership Types and Regulations:

A. General Member: You will be Member of this organization for the year you pay (Fiscal Year Aug- Jul) Fees: $100.00 per year.(Whenever you pay it will fall into the Fiscal year)

B. Lifetime Member: You will be the life time member of this organization with a one time fee. Fees $2000.00

C. Associate Member: Those who fulfill the requirement to be a General member but not residing in North America can be Associate member. All Members of other Clubs (like CCCL Dhaka) who have reciprocal agreement with CCCNA are entitled to be an Associate. Spouse of Deceased Ex-Cadets or Ex Teachers Cadet Colleges are eligible for Associate members. No Membership fees required. All Associate Members will be Non-Voting Members of the Organization.

Additional Information:

Optional Information (With your Consent you are releasing the information below)

Spouse Name:

Spouse Name: (FirstName LastName)

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Spouse Date of Birth:

Select Spouse Date of Birth

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Spouse Professional Details:

Spouse Professional Details

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Name of Child 1:

Name of Child 1

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Child 1 DOB

DD/MM

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Name of Child 2:

Name of Child 2

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Child 2 DOB:

DD/MM

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Name of Child 3:

Name of Child 3

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Child 3 DOB:

DD/MM

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Name of Child 4:

Name of Child 4

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Child 4 DOB:

DD/MM

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Your Home District/Place:

Your Home District/Place

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Your Hobbies/Interest:

Your Hobbies/Interest

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Membership Agreement: *

I hereby affirm that the information I provided are true according to best of my knowledge. By signing this form I agree that I will abide by the by-laws and the constitution of Cadet College Club of North America as well as be loyal member of the organization. I will not engage in any act that will be detrimental to the CCCNA or Cadet Colleges in Bangladesh. CCCNA holds all rights to cancel my membership based on violations of the honor code or by-laws. Membership payments may not be returned depending on the situation.

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