New Membership ~ MOHID ©

Please use Member portal to renew your membership if you are an existing member.

Primary Member Infomation

First Name *

Last Name *

Phone Number *

Cell Number *

Email Address *

Confirm Email Address *

Company Name

Date of Birth *

Gender*

Address1 *

Address2

Country *

State *

City *

Zip Code *

Note:

The membership amount is discounted if paid in full for the year.

Add Family/Group Information

Group Member Type *

First Name *

Last Name *

Phone Number *

Cell Number *

Email Address *

Confirm Email Address *

Company Name

Date of Birth *

Gender*

Same as Primary Member

Address1 *

Address2

Country *

State *

City *

Zip Code *

+ Add Another Family/ Group Member

Add Children Information

Use this section if you want to add (minor) children records. These records will not be added as members in the system.

First Name*

Last Name*

Phone Number

Email Address

Child Year of Birth

+ Add Another Child

Membership Type *

About Membership:

Do you want to signup membership for your family members too?

Yes No

In case of No, only primary member will be enrolled in selected membership type.

Select Membership Duration

Membership Period(s) Membership For Lifetime

Membership Start Date:

Membership End Date:

Membership Join Date: 09/03/2025

Membership Fee Type *

Before submission, please review the provided information to avoid typing mistakes.

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

Islamic Center of Peoria

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Primary Member Infomation

Note:

About Membership:

Member(s) Information:

Children Detail(s):

Membership Detail(s):

Validity:

Fee Detail(s):

Payment

Payment Methods

Or

Islamic Center of Peoria

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Primary Member Infomation

Note:

Declaration

About Membership:

Member(s) Information:

Children Detail(s):

Membership Detail(s):

Validity:

Fee Detail(s):

Payment

Payment Methods

Or

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