IAOS Regina Member Registration

Member Registration

    Name

    Email Address

    Current Address

    City

    Prov

    Postal Code

    Phone (Home)

    Phone (Cell)

    Phone (work)

    Fax

    Current Profession

    Specialization

    Spouse Information (if applying for family membership)

    Name

    Email Address

    Phone (Work)

    Phone (Cell)

    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

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    By clicking submit you are agreeing to pay one of the following membership fee.

    Membership Fee

    Monthly

    $20 Individual
    $40 Couple

    Annual

    $240 Individual
    $480 Couple