Program Registration ~ MOHID ©

Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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2 Day Clinic w/ Mahmoud Abdul-Rauf + Meet & Greet/Dinner

17
AUG

8:00 AM

18
AUG

3:00 PM

Program Fee:

One Time: $225.00

Offering Days: Saturday, Sunday

View Details

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Child's Full Name (First & Last) *

Child Grade (as of Sept 2024) *

Child's DOB (mm/dd/yyyy) *

Child's Shirt Size (YXS - AXL)*

Allergies?*

illness or disability?*

Extra comments ?*

I understand this is only for the player. NO FAMILY ALLOWED

+ Add More Registrants

3 2 Day Clinic w/ Mahmoud Abdul-Rauf + Meet & Greet/Dinner

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Masjid for your and other community member's safety.

Islamic Center of Staten Island

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2 Day Clinic w/ Mahmoud Abdul-Rauf + Meet & Greet/Dinner

1 Contact Information

2 Add Registrants

3 2 Day Clinic w/ Mahmoud Abdul-Rauf + Meet & Greet/Dinner

Payment Summary

Acknowledgement

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