General Membership Renewal

Terms:

$200 / Year

First Name: First Name Required

Last Name: Last Name Required

School Name:* School Name is Required

Year Established: Year Established is not valid

Website: Website is not valid

Name of Affiliated Islamic Center: Name of Affiliated Islamic Center is not valid

Does school share physical space with the Islamic Center?: Does school share physical space with the Islamic Center? is not valid

Yes No

Physical Address:* Physical Address is Required

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

Phone:* Phone is Required

Name of Principal/Head of School: Name of Principal/Head of School is not valid

Email of Principal/Head of School: Email of Principal/Head of School is not valid

Name of Additional Contact: Name of Additional Contact is not valid

Email of Additional Contact: Email of Additional Contact is not valid

Name of Board President: Name of Board President is not valid

Email of Board President: Email of Board President is not valid

Name of Office Administrator: Name of Office Administrator is not valid

Email of Office Administrator: Email of Office Administrator is not valid

Accredited by: Accredited by is not valid

Accredited Since: Accredited Since is not valid

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 not valid

Total Enrollment (KG): Total Enrollment (KG) is not valid

Total Enrollment (GRADES 1-5): Total Enrollment (GRADES 1-5) is not valid

Total Enrollment (GRADES 6-8): Total Enrollment (GRADES 6-8) is not valid

Total Enrollment (GRADES 9-12): Total Enrollment (GRADES 9-12) is not valid

Total Number of Alumni (8th Grade): Total Number of Alumni (8th Grade) is not valid

Total Number of Alumni (High School): Total Number of Alumni (High School) is not valid

Total Staff (Teaching Staff): Total Staff (Teaching Staff) is not valid

Total Staff (Non-Teaching Staff): Total Staff (Non-Teaching Staff) is not valid

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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