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Muslim Community Association of Ann Arbor

2301 Plymouth Rd, Ann Arbor, Michigan 48105, USA

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Membership Information

Membership Type *

Membership Type

Membership Fee Type *

Membership Fee Type

Membership Period *

Membership Fee Type

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Confirm Email Address *

Company Name

Address1 *

Address2

Country *

State *

City *

Zip Code *

Native Country

Cell Number

2 Other Information

Date of Birth

Gender

Marital Status Family Membership $200 and Individual Membership $100. Membership applications are reviewed at monthly board meeting. Dues are assessed after approval.

Spouse:

Child 1(15+):

Child 2(15+):

Child 3(15+):

Child 4(15+):

Reference 1 (Name and #):

Reference 2 (Name and #):

Spouse Email:

I Accept * Declaration

Membership Details

Start Month

January 2019

Membership Start Date

01/01/2019

Membership End Date

Start Month

January 2019

Membership Start Date

01/01/2019

Membership End Date

12/31/2021

Start Month

January 2021

Membership Start Date

01/01/2021

Membership End Date

12/31/2023

Muslim Community Association of Ann Arbor

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Membership Information

1 Contact Information

2 Other Information

Membership Details

Declaration

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