JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Pureway Ramadan Itikaf 2024 Registration
Assalam Alaykum, jazak Allah khair for your interest in attending the Pureway Ramadan Itikaf program. Please feel free to contact us at
info@palmfl.org
if you have any questions regarding the program.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and Last Name:
*
Your answer
Phone Number:
*
Your answer
Names and Phone Numbers of Additional Guests:
Your answer
Please indicate the names and ages of any guests under the age of 18:
Your answer
Are you intending to join for sunnah (full 10 days) or nafl itikaf?
Sunnah - Full 10 Days
Nafl
Undecided
Clear selection
Date and Time of Expected Arrival:
*
Your answer
Date and Time of Expected Departure:
*
Your answer
Method of Travel (air/car)
This will be used to potentially coordinate transportation depending on the registered guests.
Your answer
Will you require assistance with transportation?
This will be used to potentially coordinate transportation depending on the registered guests.
Yes
No
Clear selection
Any Special Requests or Accommodations, including dietary restrictions?
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Programs for the Advancement of Leadership for Muslims.
Report Abuse
Forms
