General Membership Renewal

Terms:

$200 / Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

School Name:* School Name is Required

Website:* Website is Required

Phone:* Phone is Required

Year Established:* Year Established is Required

Name of Affiliated Islamic Center:* Name of Affiliated Islamic Center is Required

Does school share physical space with the Islamic Center?:* Does school share physical space with the Islamic Center? is Required

Yes No

Mailing address if different from physical address: Mailing address if different from physical address is not valid

Name of Principal/Head of School:* Name of Principal/Head of School is Required

Email of Principal/Head of School:* Email of Principal/Head of School is Required

Name of Additional Contact:* Name of Additional Contact is Required

Email of Additional Contact:* Email of Additional Contact is Required

Name of Board President:* Name of Board President is Required

Email of Board President:* Email of Board President is Required

Name of Office Administrator:* Name of Office Administrator is Required

Email of Office Administrator:* Email of Office Administrator is Required

Accredited by:* Accredited by is Required

Accredited Since:* Accredited Since is Required

Type of School:* Type of School is Required

Non-profit For-profit

Check all that apply:* Check all that apply is Required

Boys Only School Girls Only School Co-ed Full-Time School Weekend School Boarding School

Total Enrollment (PRE-K):* Total Enrollment (PRE-K) is Required

Total Enrollment (KG):* Total Enrollment (KG) is Required

Total Enrollment (GRADES 1-5):* Total Enrollment (GRADES 1-5) is Required

Total Enrollment (GRADES 6-8):* Total Enrollment (GRADES 6-8) is Required

Total Enrollment (GRADES 9-12):* Total Enrollment (GRADES 9-12) is Required

Total Number of Alumni (8th Grade):* Total Number of Alumni (8th Grade) is Required

Total Number of Alumni (High School):* Total Number of Alumni (High School) is Required

Total Staff (Teaching Staff):* Total Staff (Teaching Staff) is Required

Total Staff (Non-Teaching Staff):* Total Staff (Non-Teaching Staff) is Required

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Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Coupon Code:

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General Membership Renewal

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