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Ummah Society - Ummah Mosque and Community Center

6225 Chebucto Road, Halifax, Nova Scotia B3L1K7, CA

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"Try Taekwondo Camp with World-Class Coach"

16
MAR

20
MAR

Program Fee:

One Time: $50.00

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1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

Province *

City *

Postal Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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3 Payment

Payment Method

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 Ummah Society - Ummah Mosque and Community Center consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Ummah Society - Ummah Mosque and Community Center

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"Try Taekwondo Camp with World-Class Coach"

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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