Application for registration of Sisters (Please print)

Date: ________ Form No: ________

Name:

___________________________ ___________________________ _____________________

Last First Middle

Date of Birth: ___/___/___ Place of Birth: __________

Number of Children: ____________________

Address: _____________________________________________________

_____________________________________________________

Telephone: Home: (_____) ______-______ Work: (_____) ______-______

Are you willing to do volunteer work for your Islamic Center? Yes / No

If yes, what sort of work can you do for ICI?

I attest that I am willing to abide by the constitution and by-laws of ICI.

_______________________________________

Signature of Applicant