ICCL Membership
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Membership Application
As a member of the Islamic Community Center of Laurel (ICCL), you will be responsible for membership dues on an annual basis; specifically, paid by January, 31st of each year. The following is a list of the current types of membership dues which you can select from. A final selection will be made during the time when membership dues payment is made. Membership dues will be reduced by 50% for new members who join after June 30th.
Amount
Type
New Member Discount Period
Description
$60.00
Single
July 01, 2024 - December 31, 2024
A membership which is valid for a single person who meets the basic requirements for membership
$90.00
Family
July 01, 2024 - December 31, 2024
A membership which is valid for a head of household and family members including dependent and unmarried children 18 and above or parents 55 and above
×
This new membership application form is being completed by or for the head of household. Household dependents can be added after submission.
Head of Household
You must be the head of household to complete this form.
Email:
A valid email/username is required.
This username/email is already registered.
The email/username is required.
First Name:
The first name is required.
Middle Name:
middle
Last Name:
The last name is required.
Gender:
Male
Female
The gender is required.
Date of Birth:
Enter a valid date.
The date of birth is required.
Phone #:
Please enter a valid phone number
The phone number is required.
Street:
The address street is required.
City:
The address city is required.
County:
(Select One)
Prince Georges, MD
Montgomery, MD
Howard, MD
Anne Arundel, MD
Other
The address county is required.
State:
(Select One)
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
The address state is required.
Zip Code:
The address zip code is required.
Citizenship:
(Select One)
Permanent Resident
Non-Citizen
US Citizen
Other
The citizenship status is required.
Marital Status:
(Select One)
Single
Married
The marital status is required.
Current Member Reference
Do you know a current ICCL member that can serve as a reference for you? Indicating one below could speed up the process for approving your ICCL Membership Application.
I Have a Reference
You must be the head of household to complete this form.
Ref. Email:
This email is already registered.
Ref. Name:
You must be the head of household to complete this form.
Ref. Phone:
Phone