Membership Registration

Please fill out the ADAMCC MEMBERSHIP FORM, take a print out and give to us. PDF Link

ADAMCC MEMBERSHIP FORM
In the Name of Allah, the Compassionate, the Merciful
Praise be to Allah, Lord of the Universe, and Master of the Day of Judgment

ADAM COMMUNITY CENTER (ACC)
IST JAMIAH MASJID OF TROY, MI
□ Family Membership ($100- $300/year) □ Individual Membership ($50 – $150per year)
□ Associate Membership ($100 per year) for residents outside of Oakland, Macomb, St.
Claire & Wayne Counties.
Name:
Last———————————— First———————————Middle——————-

Spouse’s Name:
Last ———————————-First———————————-Middle——————–

Address:
Street————————————- Apt. #——————————————-

City ——————– State—————- County—————— Zip ———–

Home Phone: Cell Phone: ( ) Fax: ( ) ————————————————————
Email: Country of Origin(s) (Optional): ———————————————————-

Volunteer Preference:
ACC encourages its membership to volunteer in any of its various activities. Please indicate
which of the following activities you are interested:
□ Membership □ Facilities □ Newsletter/Communication □ Da’wah/Interfaith □ Trainer □ Imam
□ Finance □ Social Programs □ Youth Activities □ Library □ Health official
□ Education □ Election Committee □ Fund Raiser □ Teacher □ Nursing
□Other Skills that ACC can utilize:——————————————————————————–
Check—o—matic Information (Minimum $50 per month):
Are you interested in a monthly Check—o—matic deduction for membership fee or donation? If yes, please indicate amount $——————————————————————-
Please attach a voided check with this application form for check—o—matic deduction. Member’s

Rights and Responsibilities:
Member’s rights, privileges, and responsibilities are using the ADAMCC Banquet/ Cafe facility at
reduced rate for wedding Birthday part, graduation etc. Reference for Children acting as volunteers to different institutions for social and cultural services. Education to ADAMCC Madrassa at a reduced rate and scholarship to poor students at the madrassa. Receiving continuous emails and updates.
Declaration
ADDRESS : ADAMCC
3635 Rochester Road
Troy, MI 48083.
Tel: 248-990-2236 S. Mahmood, Dr. N.Amin : 248-462-3907

By signing this form and attaching a voided check, I authorize ADAMCC to do Electronic Fund Transfer for Direct Payments (Automated Clearing House Debits) of above amount from my checking account in the following bank. This authorization will remain in effect until terminated in writing by me.
Your contribution is Tax deductible as per IRS 501 c (3)