Program Registration ~ MOHID ©

Program Information

Quraan Academy

Registration Open

Reserved Seats: 1/200

Monthly Payment: Yes Number of Months: 8

Program Start Date: 09/01/2025 Program End Date: 05/30/2026

$800.00 $100.00 $900.00

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

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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.

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Since you purchased free Ticket No Payment Required.

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Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

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Account Number*

Routing Number*

Account Type*

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

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Payment Summary

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Total Cost

Islamic Community Center of Illinois

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Program Information

Quraan Academy

1 Contact Information

2 Add Registrants

3 Payment

Payment Methods

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