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Memphis Islamic Center MIC

10225 Humphrey Road, Cordova, Tennessee 38018, USA

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(Weekly Option) Thrive Summer Program for Teens (Boys & Girls 13-18)

16
JUN

10:00 AM

17
JUL

2:00 PM

Program Fee:

One Time: $50.00

Offering Days: Monday, Tuesday, Wednesday, Thursday

Reserved Seats: 5/20

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 Program

Please list any allergies we should be aware of

Please list any medical conditions we should be aware of

Please list any medications we should be aware of

Dietary restrictions:

Emergency Contact Name & Phone Number

+ Add More Registrants

3 Payment

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

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

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Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

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Payment Summary

Program Fee

Total Registrants

Total Cost

Memphis Islamic Center MIC

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(Weekly Option) Thrive Summer Program for Teens (Boys & Girls 13-18)

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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