Membership Form | Shah-Jalal Masjid

Member Information

First Name *

Last Name *

Date of Birth *

Address *

Postcode *

Home Telephone

Mobile Telephone *

Email Address * Email addresses do not match

Confirm Email Address * Email addresses do not match

Emergency Contact Information

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Address *

Emergency Contact Postcode *

Emergency Contact Mobile *

Emergency Contact Email Email addresses do not match

Confirm Emergency Contact Email Email addresses do not match

Children Information

How many children do you have?

Other Details

Year of arrival in Rawtenstall

Any Outstanding Fees?

Payment Information

Monthly Membership Fees:

£20.00 monthly - Standard membership
£10.00 monthly - For 18+ youth who are working or those who would like to contribute

Bank Transfer Details:

Bank: NatWest Bank
Account Name: Shahjalal Mosque
Sort Code: 01-07-29
Account Number: 25411497
Reference: Please use your Member ID (provided after approval) or the first line of your address

Payment Instructions:

Set up a standing order for the 28th of each month
You will receive your Member ID in the approval email
Standing orders are preferred as they automate the process

I understand the payment requirements *

Membership Pledge

I do not hold membership of any organisation, official or otherwise, that may result in a conflict of interest with ShahJalal Mosque, Rawtenstall. Further, I freely present myself for the membership of ShahJalal Mosque, Rawtenstall, I completely agree with and will follow its aims, objectives, rules and its constitution. I will always seek the pleasure of Allah (SWT) and uphold my love for the Holy Prophet Muhammad (Peace Be Upon Him) to the highest rank in my heart & mind. I will present Islam in its true form; promoting peace, tolerance, wisdom, brotherhood, democracy, harmony, unity whilst rejecting any interpretation leading to violence, hatred, terror and extremism.

I agree to the membership pledge *

Digital Signature

Please sign below using your mouse or finger: