Triad Muslim Women Alliance Membership Application

Mission Statement:

To empower Muslim women through education, mentorship, and social engagement while establishing a strong sense of community, sisterhood, and contributing to the greater good.
Individual Member Contact Information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email: *
Phone Number*
Please enter a valid phone number.
Social Media Handle(s)*
Facebook | Instagram
Which leadership opportunity would you be interested in? (select only ONE)*

PresidentVice PresidentSecretaryTreasurerMembership CoordinatorCommunications OfficerNone
Which committee would you be interested in? (select only ONE)*

Community ServiceEducationHealth & WellnessMentorshipsSocial Engagement
How did you hear about TMWA? (select only ONE)

TMWA EventInstagramFacebookWord of MouthTMWA MemberOther
If you selected 'Other' type how you heard about TMWA; if you selected 'TMWA member', please type their name below.
Emergency contact
Name*

First NameLast Name
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Duration of Membership

From the date of membership approval to date of membership renewal. Club memberships are non-refundable and are renewed annually.

Purpose of Annual Membership Fee

The fee covers administrative expenses, swag, meeting space, help to offset event expenses, and is part of completing the online application.

Membership Payment

You may pay your membership dues in full or pay in two payments within the quarter. You are not an active member until payment is received in full.
Your Payment Method (select one)*

Credit CardCash App: $TMWA24
CASH APP PAYERS ONLY!

Membership - FULL PAYMENT $180.00Membership - PARTIAL PAYMENTS (2 payments of $90.00 due) $90.00
ATTENTION: If you are paying with CASHAPP, select your payment method and immediately submit your payment via CASHAPP $TMWA24. DO NOT COMPLETE THE CREDIT CARD SECTION BELOW. SKIP THE CREDIT CARD SECTION. Add your signature then submit the form. Thank you.
CREDIT CARD PAYMENTS ONLY!

Complete the section below if paying with a credit card