Program Registration ~ MOHID ©

Registration Open

Adult / Kids Arabic Workshop

06
DEC

13
DEC

Program Fee:

One Time: $50.00

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Reserved Seats: 0/20

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

Adults Program

Boys (7-12)

Girls (7-13)

Kids (4-6)

+ 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.

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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 Islamic Society of Annapolis 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

Islamic Society of Annapolis

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Adult / Kids Arabic Workshop

1 Contact Information

2 Add Registrants

3 Payment

Payment Methods

Or

Payment Summary

Acknowledgement

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