Islamic Center of Zahra (SA)
1059 Serpentine Lane, Pleasanton CA-94566

Member Registration Form

Registration Fee: $5 for the application
Individual Family of two Family of three or more
$25/month $30/month $40/month
Name(*)
Please enter your full name (minimum 4 characters)

Street Address(*)
Enter valid street address

City(*)
Enter Valid City Name

State(*)
Invalid Input

Zipcode(*)
Enter valid Zip code

Phone(*)
Please enter valid phone number (123-456-780)

I'm 18 years or older(*)
Invalid Input

Date of Birth(*)
/ / Invalid Input

I will abide by the ICZ Constitution(*)
Invalid Input

Applying for Membership AS(*)

Invalid Input

Username(*)
Please provide unique username!

E-mail(*)
Please provide a valid e-mail!

Verify E-mail(*)
Retype the e-mail!

Password(*)
Please enter a password!

Verify Password(*)
Retype the password!

Marital Status(*)
Invalid Input

Spouse Name
Invalid Input

Spouse Faith(*)

Invalid Input

Spouse E-mail
Invalid Input

Spouse Phone
Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

Add Dependant
Invalid Input

Name
Invalid Input

Relationship
Invalid Input

Date of Birth
Invalid Input

Shall follow Fiqh-e-Jafria Ithna Ashri & will abide by ICZ constitution(*)

Invalid Input

I hereby certify that the information entered in this application form is true and correct to the best of my knowledge and belief. I will pay my monthly dues through one of the following options:
(*)

Invalid Input

Captcha
Invalid Input

Pleasanton - United States


Monday, Shawwal 29, 1438

July 24, 2017
Fajr 4:33 am
Sunrise 6:05 am
Duhr 1:14 pm
Asr 5:05 pm
Maghrib 8:41 pm
Ishaa 9:41 pm
Shawwal Islamic Events
1st Eid-ul-Fitr
8th Jannat-ul-Baqee Demolished
10th Ghaibat Kubra started
17th Battle of Uhd
25th Shahdath Imam Jafar Sadiq (AS)
Legend



Celebration
Commemoration
Other
Click here for all important events