NHIC Member Contact Information

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Assalamu Alakum Dear Brothers and Sisters,
NHIC Executive Committee is in process to update all the Master Membership List. If you are 18 years and older, We are humbly asking You to fill up the following contact information to validate your NHIC membership. You are required to resubmit all your information even if you previously filled out the membership form.
Jazakum Allah Kula Khairan!

By checking the following box, I certify that I am 18 years or older. *

By checking here, I certify that I am 18 years or older

Required

Last Name *

First Name *

Gender *

Female

Male

Phone Number *

Address (Please include your street address, city, and zip code) *

What year did you approximately join NHIC? *

We are currently using the WhatsApp application to keep our Community informed and to give our Community a means to interact. Would you like to be added to NHIC WhatsApp Group Chat? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms