Program Registration ~ MOHID ©

Masjid Omar bin Abdul Aziz

955 Harbins Rd, lilburn, Georgia 30047, USA

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Registration Open

Spark of Ilm

26
AUG

12:30 PM

14
MAY

2:00 PM

Program Fee:

One Time: $300.00

Monthly: $37.00 (Number of Months: 8)

Offering Days: Tuesday, Wednesday, Thursday

Reserved Seats: 3/25

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

+ Add More Registrants

3 Payment

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.

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Methods

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*

Consent * Do you give Masjid Omar bin Abdul Aziz consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Masjid for your and other community member's safety

Masjid Omar bin Abdul Aziz

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Spark of Ilm

1 Contact Information

2 Add Registrants

3 Payment

Payment Methods

Payment Summary

Acknowledgement

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