Program Registration ~ MOHID ©

Muslim Center of Middlesex County

1000 Hoes Lane, Piscataway, New Jersey 08854, USA

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Registration Open

5K For Humanity (Palestine, Syria, Sudan)

16
AUG

10:00 AM

16
AUG

12:00 PM

Program Fee:

One Time: $25.00

Reserved Seats: 0/500

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

T-Shirt Size (XL, L, M, S)

+ Add More Registrants

3 Payment

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.

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

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Payment Methods

Or

Google pay Apple pay Credit/Debit Card eCheck/ACH

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Consent * Do you give Muslim Center of Middlesex County consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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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.

I/We acknowledge that MCMC and the organizers cannot be held liable for any injury while participating in this event.

Muslim Center of Middlesex County

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5K For Humanity (Palestine, Syria, Sudan)

1 Contact Information

2 Add Registrants

3 Payment

Payment Methods

Or

Payment Summary

Acknowledgement

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