Islamic Cultural Association

Islamic Cultural Association

35700 W 12 Mile Rd, Farmington Hills, Michigan 48331, USA

1. Member Information
2. Membership Information
3. Summary & Payment

Primary Member Infomation

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I understand that If I join one of the family memberships, I must include the number of guests (not including myself). For example, if there are 5 people in a family, under the heading above 'No. of group members' the number 4 should be written.

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About Membership:

In case of No, only primary member will be enrolled in selected membership type.

Membership Start Date:

Membership End Date:

Membership Join Date: 05/22/2024

Member(s) Information:
Name Phone Email Address Relation Gender Date of Birth Marital Status Native Country Citizenship Type
Children Detail(s):
Name Phone Email Year of Birth
Membership Detail(s):
Membership Type:
Membership Start Month Membership Join Date Membership End Date
Fee Detail(s):
Fee Type Fee Amount Per Member No. of selected Periods
Amount Per Member For Selected No. of Periods Total Members Total Amount Due


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