Program Registration ~ MOHID ©

Muslim Community Association of Ann Arbor

2301 Plymouth Rd, Ann Arbor, Michigan 48105, USA

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MCA YOUTH BOYS LOCK IN

21
DEC

7:30 PM

22
DEC

6:00 AM

Program Fee:

One Time: $20.00

View Details

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

Parent Full Name*

Parent Phone Number*

Relevant information about your child (allergies, etc) *

+ Add More Registrants

3 Payment

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

eCheck/ACH titleIcon

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*

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.

Consent * Do you give Muslim Community Association of Ann Arbor consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

Agree Decline

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

I grant permission for my child to participate in the Lock-In on December 21, 2024. I understand that the event will be supervised, and reasonable precautions will be taken for my child’s safety. I agree that my child will follow all rules and guidelines, and I may be contacted to pick them up if necessary. I release the mosque, its staff, and volunteers from liability for accidental injury except in cases of gross negligence.

Muslim Community Association of Ann Arbor

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MCA YOUTH BOYS LOCK IN

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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