Program Registration ~ MOHID ©

Islamic Center of Brushy Creek

1950 Brushycreek Rd, Cedar Park, Texas 78613, USA

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Registration Open

Lego and Robotics competition

17
MAY

10:00 AM

17
MAY

6:00 PM

Program Fee:

One Time: $50.00

Reserved Seats: 13/100

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

Attendee First and Last Name*

Age of Attendee*

Attendee date of birth*

Team name*

Team advisor name*

Competing in robotics (Age 9-18) or Lego (Age 8 and under)

+ 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 Islamic Center of Brushy Creek 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

Program Fee

Total Registrants

Total Cost

Acknowledgement

I agree to this waiver and all of its contents.

.https://icbrushycreek.org/wp-content/uploads/2022/07/ICBC-Activity-Registration-and-Liability-Waiver-Form.pdf

Islamic Center of Brushy Creek

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Lego and Robotics competition

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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