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Registration Form for Support a Child
Preferable Child Age:
Preferable Child Sex :
 
Title :
Name:
*
Complete Address:
*
Province *
Postal Code:
*
Home Phone:
*
Office Phone:
Fax Number:
Email Address:
*
Please make cheques payable to: MUSLIM WELFARE CENTRE
I wish to make a contribution by :
monthly $30
quaterly $90
half yearly $180
yearly $360
  Start Date: (mm)    (yyyy)
  End Date: (mm)    (yyyy)
Credit Card Information
Credit Card Type:
Credit Card Owner:
Credit Card Number:
Credit Card Expiry Date: * 
CVV Number: *
     
 
DONATE GENEROUSLY
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Estabilshed in 1993., Registered Charity # 89733-1732-RR-0001