This document appears to be a membership form for Auvijatri Bangladesh, a social work organization. The form requests basic contact information from potential members such as name, address, phone number, email, and Facebook URL. It also asks for blood type and a declaration agreeing to follow the organization's rules and commit to creating a social work program or house. Members further agree to contribute 10 taka per month to support Auvijatri Bangladesh's social responsibility and welfare initiatives.