Registration Form for Individuals

Name :*

Individual type :*

Select One Farmers Agro-entrepreneurs Students Professionals

Gender :*

Choose One Male Female

Date of birth :*

Education :*

Address :*

City / District :*

Select One Joypurhat Bogra Naogaon Natore Nawabganj Pabna Sirajganj Rajshahi Dinajpur Gaibandha Kurigram Lalmonirhat Nilphamari Panchagarh Rangpur Thakurgaon Barguna Barisal Bhola Jhalokati Patuakhali Pirojpur Bandarban Brahmanbaria Chandpur Chittagong Comilla Cox's Bazar Feni Khagrachhari Lakshmipur Noakhali Rangamati Dhaka Faridpur Gazipur Gopalganj Jamalpur Kishoreganj Madaripur Manikganj Munshiganj Mymensingh Narayanganj Netrokona Rajbari Shariatpur Sherpur Tangail Narsingdi Bagerhat Chuadanga Jessore Jhenaida Khulna Kushtia Magura Meherpur Narail Satkhira Habiganj Moulvibazar Sunamganj Sylhet

Upazilla / Thana :*

Mobile number :*

Alternate mobile/Land line number :

Email :

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Available land size :

Major sector of interest :*

Select One Livestock Poultry Fisheries Horticulture and cereal crops Others

Your interest (Multiple choice ok) :

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