ANNUAL MEMBERSHIP

بِسْمِ اللهِ الرَّحْمٰنِ الرَّحِيْمِ

In the name of Allah, the Most Gracious, the Most Merciful.
ANNUAL MEMBERSHIP
Full Name*

First NameMiddle NameLast Name
Marital Status*

MarriedSingleOther
E-mail*
Mobile Phone Number*

PrefixNumber
Occupation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouse Details
Full Name

First NameMiddle NameLast Name
Email
example@example.com
Mobile Phone Number

PrefixNumber
Occupation
Children
First Child Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Second Child Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Additional Info
Enter details of the remaining children
Payment Info
Membership Type*

Single - $240 per yearFamily - $300 per yearNon-Resident - $300 per yearOther
Payment Mode*

AnnuallyQuarterly - RecurringMonthly - RecurringOther

Membership Fee*

USD

Credit Card

Apple Pay

Google Pay

Cash App Pay

Identification Documents
Upload valid Photo Id

Browse Files
* Required for first time members Cancelof
Declarations
I {fullName} certify that all answers given herein are true and complete to the best of my knowledge.

I {fullName} hereby request an Annual Membership with the Islamic Center of Tri-Cities and commit to paying the annual membership fee. Additionally, I pledge to adhere to the constitution and the policies of the Islamic Center of Tri-Cities.
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