Program Registration ~ MOHID ©

1 Contact Information

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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

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3 Payment

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 *

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Expiry Date*

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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 Society of Greater Valley Forge consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Islamic Society of Greater Valley Forge

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Program Information

Fiqh of Hajj & ‘Umrah

Fiqh of Udhiyah (Qurbani) - Understanding the Sacrifice

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Islamic Society of Greater Valley Forge

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Program Information

Fiqh of Hajj & ‘Umrah

Fiqh of Udhiyah (Qurbani) - Understanding the Sacrifice

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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