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First Name *

Last Name *

Email *

Your email will be used only for MAS communications. It is our way of letting you know what is going on.

Phone 1 *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Section

Gender *

Select the Chapter closest to you. *

If there is no chapter in your area, you can still become a member by choosing "unaffiliated."

Ethnicity *

Tracking ethnicity helps us determine if we are reaching a true representation of the American Muslim community. Your response is appreciated.

Section

Birthday *

If under 18 years old, please complete the parent/guardian contact information. Membership will not be complete without parent/guardian consent.

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Email

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