Membership Form

ISLAMIC CENTER OF Des Moines

Phone(515) 255 0212 icdm.support@gmail.com

A Non Profit Religious Organization

Personal Information

Last Name:

First Name:

Middle Initial:

Date Of Birth:

Street Address:

Appartment:

City:

State:

Zip Code:

Email Address:

Home Phone:

Cell Phone:

Marital Status:

Single

Family

For Married Candidates Only

Wife's Name:

Children(Age):

Account Information

Information:

Bank Name:

Routing #:

Account #:

Automatic Withdrawal:

Monthly

One Time

If you elect the monthly payment option please complete the information section below (please include a void check):

Void Check

Date Beginning

End Date:

I give permission to the Islamic Center of Des Moines to withdraw the monthly pledge from my bank account each month. I will submit a written notice of any changes or terminations to the Islamic Center of Des Moines to adjust my account within a reasonable period of time.

Rules And Regulation

1. This membership entitles you to vote and nominate in the ICDM Elections.
2. This Masjid is run on donations; you should fill out the form above completely based on your ability. We encourage
everyone to give at least 1% of net income to the Masjid. (All donations tax deductible)
3. You agree to abide by the Constitution of the Islamic Center of Des Moines completely, and work under the guidance of the
ICDM’s constitution. (Constitution copy available upon request).
4. The ICDM Executive Board has the obligation to terminate any membership where it sees appropriate.

I have read the above and completely agree to abide by all the rules above, and the constitution of ICDM.

Amount Paid:

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ISLAMIC CENTER OF Des Moines

A Non Profit Religious Organization