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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?):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

 

We welcome your suggestions for MWHN services and/or other comments. Please include here:
________________________________________________________________________
________________________________________________________________________

________________________________________________________________________


Jazakum Allahu Khayr!

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