Branch Membership Application

Membership Form

Website

Personal Details

First Name *

Middle Name

Last Name *

Street Address *

Suburb *

State/Province *

Postcode *

Country *

Date of Birth *

Country of Birth *

Home Phone

Mobile Phone *

Email *

Membership Type

ICMG Australia Affiliated Membership ICMG Australia Branch Membership ICMG Australia Affiliate and Branch Membership

Membership Category

Regular Membership Student Membership Spouse Membership Child Membership (Free)

Membership Fee

Annual Fee

$100.00 /Annual

Payment details will be provided after your application is reviewed.

State & Branch

State *

Branch *

Membership Declaration

I would like to apply to become a member of the Islamic Community Milli Gorus. I shall abide by the rules and principles the Association has in place and undertake what is required of me.

Signature

Draw Your Signature *

Full Name *

Date

—

We'll contact you to confirm your membership.