TMYCD Registration

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.We will need to send you some very important information regarding TMCD. You will also be able to communicate with us should you have any questions.
example@example.com
3
Date of Birth
Date
Year
Month
Day
4
Phone Number* This field is required.You'll have immediate access to Capitol Day Organizers and will be able to stay up to on everything that's happening on the day of.
Please enter a valid phone number.
5
What is your school name?* This field is required.
6
Are you a student or chaperone?* This field is required.
7
Address* This field is required.Don't worry! This stays completely private. We are only asking so that you can be assigned to the correct Representative and Senator for your meeting.
Street Address
City
County
Zip Code
8
For residents of Austin and the Greater Austin metropolitan area, CAIR-Texas will not provide transportation and request that Islamic schools and/or individuals coordinate their own transportation.
9
Are You Planning on Driving or Taking a Bus - Note Bus Schedules Will be Shared Closer to Capitol Day* This field is required.Logistics are important. Texas Muslim Capitol Day is going to be in person in Austin. If you aren't sure about how you will get there it's no problem. we will coordinate with you closer to the week before. Bus rides will be low cost, InshaAllah!
I'm Planning on Drive
I need a bus ride
I'm Flexible
Not Sure
10
In consideration of the risk while participating in Texas Muslim Capitol Day (“Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in Texas Muslim Capitol Day, and do hereby release and forever discharge Council on American-Islamic Relations(“CAIR”), CAIR Texas-Houston, located at 7211 Regency Square Blvd., Suite 201, Houston, TX 77036, CAIR Texas-Austin, CAIR Texas-DFW, CAIR Texas-San Antonio, CAIR National, and all partnering and supporting organizations, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors for any injury, including but not limited to damages for personal injuries, economic and emotional losses, breach of contract, or any other injury that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.* This field is required.
Please print your name as agreement to this waiver and release form
11
Are you able to pay the $50 registration fee for Texas Muslim Youth Capitol Day?* This field is required.If not, we would still love for you to attend and request you reach out to CAIR-Texas chapter near you to see if you are eligible for a scholarship to cover attendance costs!
YESNO
12
Please click the link to pay the registration fee to help us provide the best Capitol Day. * This field is required.https://asmjbymh.donorsupport.co/login?redirectTo=%2Fpag
YESNO
13
Please verify that you are human* This field is required.
Should be Empty: