NEW Member Application
NEW Member Application
Membership Fee Type: *
Fees *
Personal Information
First Name: *
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Last Name: *
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Date of Birth *
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Gender:
Marital Status:
Address: *
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City: *
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Stated: *
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ZIP Code: *
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Phone number: (xxx) xxx-xxxx *
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Email: *
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I certify that the above information is correct, and I have read and agree to abide by the UICA Constitution. I further agree to resolve any dispute with other members or UICA Administration through Islamic arbitration and will abide by the code of ethics stated in the UICA Constitution. I further authorize recurring payments as stipulated above to be charged for my UICA membership. *
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