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Islamic Center of South Bay

25816 Walnut St, Lomita, California 90717, USA

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ICSB LA Family Game Night

22
AUG

7:30 PM

22
AUG

8:30 PM

Program Fee:

One Time: $3.00

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Reserved Seats: 9/64

1

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

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State *

City *

Zip Code *

Cell Number

2

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

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3

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.

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Credit Card Number*

Expiry Date*

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Routing Number*

Account Type*

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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Islamic Center of South Bay

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ICSB LA Family Game Night

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