Islamic Classes Registration ~ MOHID ©

1330 Castlemore Ave, Markham, Ontario L6E1A4, CA

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Evening Hifz

08
SEP

5:30 PM

30
JUN

8:00 PM

Teacher :Hafiz Qasim

Offering Days: Monday, Tuesday, Wednesday, Thursday, Friday

Partial Payment:Yes Partial Amount:$100.00 Number of Months:4

6/40

Registration Open

$480.00 $1,200.00

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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Date Of Birth DD/MM/YYYY*

Any medical conditions or allergies*

Emergency Contact Name & Relationship*

Emergency Contact Number*

+ Add More Registrants

3 Payment

Payment Method

Credit 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 Centre of Markham - Masjid Darul-Iman consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Evening Hifz

1 Contact Information

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3 Payment

Payment Summary

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