NICC Program Registration ~ MOHID ©

Noor Islamic Cultural Center - American Islamic Waqf

5001 Wilcox Road, Dublin, Ohio 43016, USA

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Family Card Making Event

22
FEB

2:00 PM

22
FEB

3:00 PM

NICC Program Fee:

One Time: $4.00

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1

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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3

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

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 Noor Islamic Cultural Center - American Islamic Waqf consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Payment Summary

NICC Program Fee

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Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Muslim Family Services and volunteers for your and other community member's safety

Noor Islamic Cultural Center - American Islamic Waqf

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Family Card Making Event

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3

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