Member Registration

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


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