NICC Program Registration ~ MOHID ©

Noor Islamic Cultural Center - American Islamic Waqf

5001 Wilcox Road, Dublin, Ohio 43016, USA

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Registration Open

MyImpact Youth Art Magazine Sponsorships

30
DEC

12:00 AM

25
JAN

12:00 AM

NICC Program Fee:

One Time: $50.00

Reserved Seats: 9/20

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 NICC Program

Business Name

+ Add More Registrants

3 Payment

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

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 Noor Islamic Cultural Center - American Islamic Waqf 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

NICC Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will email your business ad to sumaiyaa@noorohio.org and give consent for it to be placed in the first Myimpact Youth Art magazine. The sizing for your ad will reflect the amount of your donation.

$50 quarter page

$100 half page

$200 full page

Jazakallhu Khairan for your support!

Noor Islamic Cultural Center - American Islamic Waqf

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MyImpact Youth Art Magazine Sponsorships

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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