MAB Pledge FORM

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I acknowledge that I have read, understand, and accepted all the provisions contained in the terms and conditions of the Pre-Authorized payment authorization.

Note:
• Please attach a void cheque with the pledge form and mail the signed form and void
cheque to Brantford Mosque 192 Greenwich Street, Brantford, ON, Canada, N3S 2X6.
Or email to. info@brantfordmosque.ca.

• The Membership application will be subject to review and approval of MAB
Membership Administrator. If any issues or concern will update you within 60 days.

Fill-in the table and the next section, In case
if additional family members living at the same address will like to be part of MAB, please check add member and complete the form and provide the copy of government issued photo ID of family members