Member Registration | Masjid Al Nur

Register your household

Please provide current information for the primary adult and everyone living in the household. Fields marked * are required.

Please register every member of your household. Include your spouse, children, parents, relatives, and anyone else who currently lives with you. Review all names and ages carefully before submitting, as changes after registration may require assistance from Masjid Al Nur.

Primary contact

The adult we should contact about this household.

Full name * Age * Email address * Phone number *

Home address

Your current residential address.

Street address * City * ZIP code *

Polk County residency

Tell us whether your household currently lives in Polk County.

Do you currently live in Polk County? *

Yes No

Other household members

Add everyone living in the household except the primary contact listed above.

Anything else?

Optional information you would like the masjid to know.

Notes

Your information will be used only for Masjid Al Nur membership and community communication.