IEC Youth Group Membership Form
By completing this form, the IEC Youth Group will be able to better serve the youth of our community, and keep its members engaged and informed about all activities, events, and much more.
Please fill out the form if you are currently younger than 30 years old. However, if you are over the age of 30 and would like to stay informed with the IEC Youth Group, you are more than welcome to fill out this form!
Any Questions or Concerns? Please Email us at Youth@IECHusaini.org
* Required
Make sure you are connected with IEC Youth Group by following our Social Media outlets!
First and Last Name
*
Your answer
Date of Birth
Optional
MM
/
DD
/
YYYY
Phone Number
*
Your answer
Email Address
*
Email address will be used to send you official IEC Youth Group communications.
Your answer
Street Address
*
Example: 110 Ali St.
Your answer
City, State, Zip
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Example: Glendale Heights, IL 60139
Your answer
Father's First and Last Name
*
Your answer
Mother's First and Last Name
*
Your answer
Current Level of Education
*
Elementary School (Pre-K to 5th Grade)
Middle School (6th Grade to 8th Grade)
High School (9th Grade to 12th Grade)
Pursuing Undergraduate Degree
Pursuing Graduate Degree
Recently Completed Education
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