MUSLIM WOMEN'S HELP NETWORK
Mail Membership Form
Please print out, complete and send via U.S. mail to:
Muslim Women's Help Network
c/o United Muslim Movement Against Homelessness
166-26 89th Avenue
Jamaica, NY 11432
PLEASE PRINT ALL INFORMATION CLEARLY. Thank you.
NAME:
Last: _____________________________ First: _______________________ M.I.: ______
Salutation: (Brother or Sister) ________________________
ADDRESS:
Number/Street: ______________________________________ Apt. # _______________
City/Town: _________________________________ Zip Code: ______________________
TELEPHONE #s:
Home: __________________________________ Other: ___________________________
If employed, Position/Title: ___________________________________________
Employer (Optional): ________________________________________________________
E-mail address: _________________________ Website URL: _______________________
Are you interested in joining a MWHN sub-committee (Fundraising, Public
Relations, Direct Support, Education/Research, Projects Development)?
( ) Yes; please identify: ______________________________________________________
( ) No, not at this time.
If you reside in NYC, can you provide temporary housing (1-3 days) for a
sister or family during a trial of hardship? (if yes, please state the kind of
accommodations you have available, for example, a spare bedroom, lodging in a basement,
and the number of persons that you can shelter at any one time?):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
Jazakum Allahu Khayr!