Volunteer Registration

Contact Information

Name *

Street Address*

City

State *

Zip

Home Phone *

Work Phone *

Email *

Availability

During which hours are you available for volunteer assignments?

Weekday Morning Afternoon Evenings
Weekends Morning Afternoon Evenings

Interests

Tell us in which areas you are interested in volunteering (please pick only one)

 Information Dawah Booth and Events
 Converts and Friends Support Group
 Shifa Free Health Clinic
 Outreach Committee
 Quran Mobile and Quran Stands
 Community Service and Initiatives
 Audio and Video
 Food Pantry

Special Skills/Qualifications and Previous Volunteer Experience

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports

Person to Notify in Case of Emergency

Name *

Street Address*

City

State *

Zip

Home Phone *

Work Phone *

Email *

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Accept and Submit :