Program Registration ~ MOHID ©

Islamic Association of Collin County

6401 INDEPENDENCE PARKWAY, PLANO, Texas 75023, USA

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IACC SISTERS: FITNESS TRIAL CLASS

28
AUG

10:30 AM

28
AUG

11:30 AM

Program Fee:

One Time: $5.00

Offering Days: Thursday

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Reserved Seats: 0/20

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

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3

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.

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Credit Card Number*

Expiry Date*

CVV Code*

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Account Number*

Routing Number*

Account Type*

Consent * Do you give Islamic Association of Collin County consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Acknowledgement

By registering, you acknowledge that you will follow all the instructions provided to you by the Masjid for your and other community member's safety.

Islamic Association of Collin County

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IACC SISTERS: FITNESS TRIAL CLASS

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