• Muslim Gamechangers Network (MGN) Registration

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  • Which Masjid are you registering with?

  • Student Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Parent/Guardian/Emergency Contact

  • Format: (000) 000-0000.
  • Would you be open to receiving emails from us?

  • Program

    Students will fill this out.
  • How did you hear about the program?*

  • Media Release Form

    Muslim Gamechangers Network

  • This form grants permission to the CAIR-CA to use your likeness and information for purposes related to the MGN.


    Please review carefully before signing.
    By signing below, you grant CAIR-CA the right to:

    • Use your full name, personal information, biography, and photo/video image.
    • Use your likeness (including pictures, photographs, silhouettes, etc.) in various media formats.
    • Distribute, advertise, promote, exhibit, and exploit your likeness worldwide, in perpetuity, and on any media format (existing or future).
      You also agree to:
    • Not to sue CAIR-CA for using your likeness as authorized in this form. This includes claims based on invasion of privacy or publicity rights.
    • Release CAIR-CA, its directors, officers, and associates from any liability related to the use of your likeness as authorized in this form.

    Please note:

    • This permission is granted for the Muslim Gamechangers Networking Program.
  • Choose one of the following:

  • Registration Fee*

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    Student Registration Fee Product Image
    Student Registration Fee
    $25.00$25.00
    Item subtotal:$0.00$0.00
      
    Total
    $0.00$0.00
    Debit or Credit Card
  • Should be Empty: