Program Registration ~ MOHID ©

Islamic Center of South Bay

25816 Walnut St, Lomita, California 90717, USA

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Registration Open

Family Night: I love my Parents

16
MAY

6:30 PM

15
MAY

7:30 PM

Program Fee:

One Time: $5.00

View Details

Reserved Seats: 29/50

1

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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3

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of South Bay consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Total Registrants

Total Cost

Islamic Center of South Bay

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Family Night: I love my Parents

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