Islamic Society of Central Virginia

ISLAMIC SOCIETY OF CENTRAL VIRGINIA

Membership Status (please check one) Non Student ($25 due) Student (UVA or PVCC) ($10 due)
Application Information
Full name of applicant:
Age:		Gender:
Spouse's name:
Street Address:				City:
State:		Zip:		Email:
Telephone Number:
Home:		Work:		Cell:
Language(s) spoken:	EnglishArabicPersian			Other:
*Nationality (Optional):			*Occupation (Optional):
**Please include the following information in the ISCV Membership Directory (optional):
Contact InformationNationalityOccupation
* Information on nationality and occupation would allow ISCV to refer interested parties from the Muslimcommunity for any professional service or voluntary assistance that you’re willing to provide. Note: As a ISCV Member you will automatically recieve email updates from ISCV.

If you wish to make the payment by check or cash please download the form here. Complete the form and mail it to ISCV – Membership P.O. Box 3403 Charlottesville, VA 22903