Please fill out the form below to register for the course(s) of your choice.

All information provided will be kept strictly confidential.
 

Part Time Course Registration

Which course(s) are you registering for? *

Part-Time Islamic School

Essentials of Islam: Part-time Course for Adults

Last Name *

First Name(s) *

Date of Birth *

dd/mm/yyyy

Gender * Male Female

Address Line 1 *

Address Line 2

Email Address *

All correspondence will be sent to this email. Please assure it is valid and checked regularly.

Phone *

111-222-3333

How did you hear about the course? *

Google Search

Facebook

Newspaper

From a friend

Masjid

Other

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