New Membership ~ MOHID ©

Member(s) Information:

Name	Phone	Email	Address	Relation	Gender	Date of Birth	Marital Status	Native Country	Citizenship Type

Children Detail(s):

Name	Phone	Email	Year of Birth

Membership Detail(s):

Membership Type:

Validity:

Membership Start Month	Membership Join Date	Membership End Date

Fee Detail(s):

Fee Type	Fee Amount Per Member	No. of selected Periods

Amount Per Member For Selected No. of Periods	Total Members	Total Amount Due

Auto Renewal if this option is enabled ,then System will save this Payment information as default payment method for this Member and will automatically renew this membership on the day after the membership expires.

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Recurring Start Date*

Number of Months*

For Lifetime

Recurring Information

Note: Monthly recurring amount is calculated by dividing the Amount Due with Number of Months.

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Total Amount Due

Amount Paying

Payment Methods

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Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

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Consent * Do you give Birmingham Islamic Society consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Birmingham Islamic Society

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Primary Member Infomation

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Member(s) Information:

Children Detail(s):

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Fee Detail(s):

Payment

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Birmingham Islamic Society

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Primary Member Infomation

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About Membership:

Member(s) Information:

Children Detail(s):

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Validity:

Fee Detail(s):

Payment

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