Program Registration ~ MOHID ©

Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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Beginner Arabic Course

28
JAN

12:00 AM

14
APR

12:00 AM

Program Fee:

One Time: $300.00

Offering Days: Sunday

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

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Primary Contact as First Registrant

Registrant Name*

Email Address

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Full Name (First & Last) *

DOB (mm/dd/yy)*

How did you hear about our program?*

Do you know the Arabic alphabet?*

Comments/Concerns

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3 Beginner Arabic Course Winter 2024

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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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 Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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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 Center of Staten Island

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Beginner Arabic Course

1 Contact Information

2 Add Registrants

3 Beginner Arabic Course Winter 2024

Payment Summary

Acknowledgement

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