ACON Las Vegas Membership Application

Your Name


Home Phone

Mobile Phone

Your Primary E-mail

Name of your Spouse (if applicable)

Spouse’s Phone

Spouse’s Email

Children? Name and Age

Gender M F Name and Age

Gender M F Name and Age

Gender M F Would you like to volunteer for the Center?
Yes No Comments?

I agree to support the program and services of ACON Las Vegas and agree to abide by its bylaws*. I understand that the bylaws may be amended and revised from time to time. All of my family members and I listed on this application do hereby agree to indemnify and hold harmless ACON Las Vegas, executive committee members, directors, officers, managers, employees, and other agents against any claims, liability, loss, damage or expense of any nature whatsoever. Membership may be revoked if a member has disregarded the provisions of ACON Las Vegas, bylaws, and Islamic values.

I agree to pay monthly membership fee for ACON Las Vegas as determined by the Executive Committee.

Monthly donation amount:
Other amount $_______


Signature of Spouse (if applicable)

For Official Use Only
Membership No._____________
Approved By:_______________ Signature:__________________
Title:______________________ Date:_____________________


*Available on request by emailing to the Secretary of ACON Las Vegas or by viewing it online by clicking below.