Name Email Address Current Address Ph (H) Ph (C) Fax Ph (w) City Prov Postal Code Current Profession Specialization SPOUSE INFORMATION (If Apply For Family Membership) Name Email Address Ph (W) Ph (C) Current Profession Specialization Please provide two references below. Name Email Phone DECLARATIONS (Circle appropriate response) I am a Muslim over the age of 18 YesNo I am Permanent resident OR Citizen of Canada(Will provide proof upon request) YesNo I am living in Saskatchewan for at least six months(Will provide proof upon request) YesNo I will abide by the constitution and By-Laws of IAOS Regina Inc. YesNo I am not a member of any other Islamic Organization in Saskatchewan YesNo Please fill this field with letters on RIGHT of Captcha field
