JIAR Program Registration ~ MOHID ©

Jamaat Ibad Ar Rahman

3034 Fayetteville St 27707, 5122 Revere Rd 27713, Durham, North Carolina, USA

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JIAR 2024 FUNDRAISER

02
MAR

5:00 PM

02
MAR

10:00 PM

JIAR Program Fee:

One Time: $30.00

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 JIAR Program

+ 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 Jamaat Ibad Ar Rahman consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Since you purchased free Ticket No Payment Required.

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Payment Summary

JIAR Program Fee

Total Registrants

Total Cost

Jamaat Ibad Ar Rahman

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JIAR 2024 FUNDRAISER

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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