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Islamic Cultural Association

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

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Summer Sports & Arabic Program (KG & 1st Grade) member discount code : Sports

16
JUL

6:00 PM

15
AUG

8:30 PM

Program Fee:

One Time: $180.00

Offering Days: Tuesday, Thursday

Reserved Seats: 14/20

1 Parent Name (First and Last)

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Child name ( first & last)

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Child's First and Last Name*

Child's Grade (as of next year)*

Child Age*

+ 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 Islamic Cultural Association consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

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 Cultural Association

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Summer Sports & Arabic Program (KG & 1st Grade) member discount code : Sports

1 Parent Name (First and Last)

2 Child name ( first & last)

3 Payment

Payment Summary

Acknowledgement

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