Ummah Mosque and Community Center

2510 St Matthias St, Halifax, Nova Scotia B3L0A9, CA

Halifax

Home

Donations Tickets Pledge Sign Up Login

New Membership

Basic Information

Membership Type: *

Membership Fee Type: *

Membership Period: *

Personal Information

First Name: *

Last Name: *

Company Name:

Display As: *

Login ID: *

Create a Login Id

Other Information

Date of Birth: *

Gender:

Marital Status:

Contact Information

Address1: *

Address2:

Country: *

State: *

City: *

Zip Code: *

Phone Number: *

Cell Number:

Email Address: *

Native Country:

Declaration

I Accept: *

View Declaration

: *

Membership Details

Start Month: September 2018

Membership Start Date: 09/01/2018

Membership End Date:

Start Month: September 2018

Membership Start Date: 09/01/2018

Membership End Date: 08/31/2019

Start Month: September 2019

Membership Start Date: 09/01/2019

Membership End Date: 08/31/2020