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Membership Application Form
www.uwms.org
members@uwms.org
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Applicant Details
Membership
*
New
Renewal
Payment Option
*
Annual (1 payment) Family $1080
Annual (1 payment) Single $540
Monthly (12 payments) Family $90
Monthly (12 payments) Single $45
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Cell Phone
*
Your answer
Gender
*
Male
Female
Spouse's First Name
Your answer
Spouse's Last Name
Your answer
Spouse's Email
*
Your answer
Address (incl. City, State & Zip)
*
Your answer
Home Phone
Your answer
Preferred Method of Contact
*
Email
Cell Phone
Home Phone
How many children under 18 years of age?
*
Choose
0
1
2
3
4
5
Do you have any children enrolled at the Saturday Islamic School at UWMS?
*
Yes
No
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