Albuquerque Islamic Center Membership

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Thank you for taking the time to fill out a masjid membership application. If you have any changes in the future, please let us know so we can keep the most up-to-date information in our system. We will use this information to keep you informed and also to help connect you with other believers.

Family Name *

Year Joining *

Mailing Address *

Household Name (First and Last) *

Gender *

Male

Female

Prefer not to say

Age *

Cell phone *

Email *

Number of Dependents

Clear selection

Age Range of Dependents

< 2

3 - 5

6 - 11

12 - 1

> 14

Comfort Level of Quran Recitation

Not comfort

Some comfort

Very comfort

Clear selection

Masjid and Community Volunteer

Not interested

I will thinkg about it

Some how interested

Very interested

Clear selection

Feedback and Ideas

Submit

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