American Moslem Foundation
(A registered charitable foundation in the state of Washington)
- Member/Donor Registration - *
(*) All data is held confidential by the American Moslem Foundation
Print out this form and mail the completed form to:
American Moslem Foundation;15004 SE 256th St Covington, WA, 9804

or fax it to:253-588-8787

If you need additional information, call (253) 638-9989

NAME: __________________________________PHONE: (___)_________ FAX: (___)__________ 

 
HOME ADDRESS: ____________________________CITY: __________STATE: ____ZIP CODE _____
E-MAIL: ___________________MOBILE: (___)______________ WORK PHONE: (___)___________

BIRTH DATE: _________________ ARE YOU? MALE_____ FEMALE_____ PROFESSION: ______________________

MARITAL STATUS: SINGLE_____ MARRIED______ NO. OF CHILDREN_________ MALE______ FEMALE________

WHICH AMF PROJECT IS OF MOST INTEREST TO YOU?
ALL-MUSLIM CEMETERY _______ SPECIALIZED INSTRUCTION SCHOOL ________ EBRAHIM MOSQUE ________

MONTHLY MEMBERSHIP/DONOR CONTRIBUTION LEVEL: $20____$50____ $100____ $250____ OTHER_________

CONTRIBUTION METHOD: CHECK____ CREDIT CARD: _____VISA____ MASTERCARD____ OTHER CARDS______

NAME : ________________CREDIT CARD NUMBER: ________________________ EXPIRATION DATE: _________

SIGNATURE: __________________________________________DATE___________

 

THANK YOU FOR YOUR SUPPORT OF AMF; GOD'S BLESSING IS PROMISED TO THE GROUP OF MUSLIMS!