MEMBERSHIP FORM

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Name

First

Last

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Gender

Date of Birth

Address

Address Line 1

Address Line 2

City

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Postal Code

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Phone

EMERGENCY CONTACT INFORMATION

Name & Relationship

Contact of Relationship

DECLARATION

I am a Muslim of Shia Ithna Ashri faith and wish to apply for the membership of Masjid & Imambargah Shuhdae Karbala.
I also wish to apply for the membership of my family members (if applicable).
I can confirm that I am able and willing to pay an annual membership fee (including my family members, if applicable) in the sum of £100.00
I can confirm that my family members and I shall abide by the constitution of Masjid & Imambargah Shuhdae Karbala.

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Family Member – 1

Family Member – 3

Name of Member

Family Member – 2

Family Member – 4

Signature

Membership Fee

Minimum Price: £10.00

Membership Payment (Debit/Credit Card)

A/C Title: Masjid & Imambargah Shuhdae Karbala
Zempler Bank, Sort Code: 08-71-99 Account No: 14830689

Masjid & Imambargah Shuhdae Karbala, 383, Barking Road, London, E13 8AL
Phone: 07984 434 567, Email: info@shuhdaekarbala.org.uk
Registered with the Charity Commission of England & Wales (Reg No. 1187832)

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Masjid & Imambargah Shuhdae Karbala
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383, Barking Road, London, E13 8AL | Registered Charity No: 1187832

MEMBERSHIP FORM

A/C Title: Masjid & Imambargah Shuhdae Karbala
Zempler Bank, Sort Code: 08-71-99 Account No: 14830689

You can also download this Membership form: Click Here

MEMBERSHIP FORM

A/C Title: Masjid & Imambargah Shuhdae Karbala Zempler Bank, Sort Code: 08-71-99 Account No: 14830689

You can also download this Membership form: Click Here

A/C Title: Masjid & Imambargah Shuhdae Karbala
Zempler Bank, Sort Code: 08-71-99 Account No: 14830689