29707 WEST 10 MILE ROAD, FARMINGTON HILLS, MI 48336. WWW.TAWHEEDCENTER.ORG 248-426-7360 MAIL@TAWHEEDCENTER.ORG

MEMBERSHIP APPLICATION FORM (ALL DONATIONS ARE FEDERAL TAX EXEMPTED)

FAMILY MEMBERSHIP SINGLE MEMBERSHIP ($100)

($200 OR > $25 MONTHLY DONATION) ($100 OR > $15 MONTHLY DONATION)

NAME: (LAST) (FIRST) (MIDDLE INITIAL)

SPOUSE: (LAST) (FIRST) (MIDDLE INITIAL)

STREET ADDRESS APT.# CITY STATE ZIP

HOME PHONE:

EMAIL: SPOUSE’S EMAIL:

PLEASE PROVIDE REFERENCE OF ONE TAWHEED CENTER MEMBER:

MEMBERSHIP PAID BY:

CHECK

AUTOMATIC DEDUCTION BANK NAME AND ACCOUNT #:

BANK ROUTING NUMBER:

CREDIT CARD NAME ON CARD #: CARD #

EXPIRATION DATE: CVV2#

BILLING ADDRESS FOR CREDIT CARD: (IF SAME AS MAILING ADDRESS, CHECK HERE - )

STREET ADDRESS APT.# CITY STATE ZIP

ARE YOU CURRENTLY RECEIVING TAWHEED CENTER EMAIL? YES NO

IF NO, WOULD YOU LIKE TO BE ADDED TO THE LIST? YES NO

I/WE HEREBY DECLARE THAT I/WE SHALL ABIDE BY THE CONSTITUTION AND BY-LAWS OF

TAWHEED CENTER (A COPY OF THE CONSTITUTION IS AVAILABLE AT WWW.TAWHEEDCENTER.ORG).

SIGNATURE: (SELF) DATE:

SIGNATURE: (SPOUSE) DATE: