Program Registration ~ MOHID ©

Memphis Islamic Center MIC

10225 Humphrey Road, Cordova, Tennessee 38018, USA

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Registration Open

Vendor Registration

26
OCT

2:00 PM

26
OCT

6:00 PM

Program Fee:

One Time: $50.00

Offering Days: Sunday

Reserved Seats: 46/50

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

Vendor/Business Name*

Type of Vendor (Food, Merchandise, Non-Profit, etc)*

Description of Business*

+ Add More Registrants

3 Vendor Fee

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.

Comments

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 Memphis Islamic Center MIC consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

Agree Decline

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 mentioned below. - Please don't use the electrical outlets - Kitchen will not be available for use - Only 1 Table & 1 Chair will be provided - Due to limited space, please be mindful of amount of merchandise you will bring - Limited availability ~30 spots - Deadline to sign up Wednesday October 15th.

Memphis Islamic Center MIC

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Vendor Registration

1 Contact Information

2 Add Registrants

3 Vendor Fee

Payment Methods

Or

Payment Summary

Acknowledgement

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