Application Form - Couples Retreat In Iran April 2019
Thank you for your interest in this course.

Before completing the application please read through the Terms and Conditions here: https://www.world-federation.org/news/couples-retreat-course-terms-and-conditions.

Then you may fill in this application form with as much detail as possible. This will help us quickly process your application.

As part of the application, please pay a deposit fee of GBP 200/ USD 250 / EUR 250 by 4th February 2019 to secure a seat for you and your spouse by clicking here - https://www.world-federation.org/donate-2/. In the ‘Search for a campaign or cause’ field, type ‘Couples Retreat’.

More details can be found about our Couples Retreat here: https://www.world-federation.org/CouplesRetreat2019

Email address *
Section 1 - To be completed by the Husband
Husband's Full Name (as per passport) *
Your answer
Husband's Father’s Name *
Your answer
Spouse's Full Name (as per passport) *
Your answer
Husband's Date of Birth *
MM
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DD
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YYYY
Marriage Date *
MM
/
DD
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YYYY
Husband's Age *
Your answer
Name of Husband's Jamaat / Islamic Centre *
Your answer
Husband's ethnic background (e.g. Khoja, Pakistani, Irani etc..) *
Your answer
Postal Address *
Your answer
City of Residence *
Your answer
Country of Residence *
Your answer
Husband's Email Address *
Your answer
Husband's mobile/cell number with country code (no spaces) *
Your answer
Husband's home telephone number with city / country code *
Your answer
Husband's Passport Number *
Your answer
Husband's Nationality (as per passport) *
Your answer
Husband's Issuance date of Passport *
MM
/
DD
/
YYYY
Husband's Expiration date of Passport
MM
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DD
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YYYY
Has the husband ever previously attended any of The World Federation's courses such as Madinah & Bab summer courses for youths, Leadership Development Programme, CPD Courses, or any other course? Please include the year attended. *
Your answer
This question is very important and will form part of the criteria when assessing your application. In no more than 300 words, please describe why you (the husband) wants to attend this course and how will you use this experience if you are selected. *
Your answer
Please state the husband's occupation and in what subject / field / occupation? (e.g. studying/working/gap year) *
Your answer
Please tell us in detail about your (the husband's) educational history in Islamic subjects - including any current Islamic education - with dates, names and locations of institutions, subjects studied and results achieved. Also include details of Madrasah studies, etc... *
Your answer
Please tell us about any disabilities, illnesses, or medical needs the husband may have. *
Your answer
Please tell us about any learning difficulties or behavioural disorders such as ADD / ADHD the husband may have. *
Your answer
Please tell us about any dietary requirements/allergies that the husband may have. *
Your answer
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