MASJID NOOR LONG ISLAND
11032 Park Ave, Huntington, NY 11743
feedback@masjidnoorli.net
www.masjidnoorli.net
(631) 683-4185
Registration Form
Parents Information
Group leader
*
First Name
Last Name
Group leader Mobile Number
*
Please enter a valid phone number.
Group leader Email
*
example@example.com
Select Participants
Select Fee Package
*
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Registration Fees
$
85.00
Quantity
Price
Number of Participants ( Including Parents )
1
2
3
4
5
6
7
8
$
85.00
Item subtotal:
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: