Program Registration ~ MOHID ©

MASJID AL-WALI

10 Olsen Avenue, Edison, New Jersey 08820, USA

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Family Fun Night

31
OCT

4:30 PM

31
OCT

6:30 PM

Program Fee:

One Time: $28.00

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Children

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Which school does child attend (Al-Wali or MCMC)*

What grade are they in?*

+ 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 MASJID AL-WALI 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

Jazak Allah Khair for registering for Family Fun Night.

MASJID AL-WALI

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Family Fun Night

1 Contact Information

2 Add Children

3 Payment

Payment Summary

Acknowledgement

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