MEMBERSHIP APPLICATION FORM - Tawheed Center29707 west 10 mile road, farmington hills, mi 48336....
Transcript of MEMBERSHIP APPLICATION FORM - Tawheed Center29707 west 10 mile road, farmington hills, mi 48336....
29707 WEST 10 MILE ROAD, FARMINGTON HILLS, MI 48336. WWW.TAWHEEDCENTER.ORG 248-426-7360 [email protected]
MEMBERSHIP APPLICATION FORM (ALL DONATIONS ARE FEDERAL TAX EXEMPTED)
FAMILY MEMBERSHIP SINGLE MEMBERSHIP ($100)
($200 OR > $25 MONTHLY DONATION) ($100 OR > $15 MONTHLY DONATION)
NAME: (LAST) (FIRST) (MIDDLE INITIAL)
SPOUSE: (LAST) (FIRST) (MIDDLE INITIAL)
STREET ADDRESS APT.# CITY STATE ZIP
HOME PHONE:
EMAIL: SPOUSE’S EMAIL:
PLEASE PROVIDE REFERENCE OF ONE TAWHEED CENTER MEMBER:
MEMBERSHIP PAID BY:
CHECK
AUTOMATIC DEDUCTION BANK NAME AND ACCOUNT #:
BANK ROUTING NUMBER:
CREDIT CARD NAME ON CARD #: CARD #
EXPIRATION DATE: CVV2#
BILLING ADDRESS FOR CREDIT CARD: (IF SAME AS MAILING ADDRESS, CHECK HERE - )
STREET ADDRESS APT.# CITY STATE ZIP
ARE YOU CURRENTLY RECEIVING TAWHEED CENTER EMAIL? YES NO
IF NO, WOULD YOU LIKE TO BE ADDED TO THE LIST? YES NO
I/WE HEREBY DECLARE THAT I/WE SHALL ABIDE BY THE CONSTITUTION AND BY-LAWS OF
TAWHEED CENTER (A COPY OF THE CONSTITUTION IS AVAILABLE AT WWW.TAWHEEDCENTER.ORG).
SIGNATURE: (SELF) DATE:
SIGNATURE: (SPOUSE) DATE: