Embracing Islam Request Form
Name (as shown on ID)
*
First Name
Last Name
Email
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Please provide a valid email address, as it will be used for correspondence related to this submission.
Phone Number
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Area Code
Phone Number
Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
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Marital Status
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Gender
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How did you know about Islam?
*
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When did you take your Shahada, or when would you like to take it?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Declaration of Faith
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I testify that there is no God worthy of worship except Allah, and that Mohammed is His final messenger. Through this declaration of faith, I have chosen to embrace the religion of Islam. As a Muslim, I vow to uphold the teachings of Islam throughout my life. I strictly want all of my burial arrangements and the distribution of my wealth to be according to Islamic law.
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