Membership Application

First Name: Last Name: Email: Phone: Address: City: State: Zip: -

MONTHLY Student Member Contributions

$10

$25

$52

$10

$25

$52

While a member is in high school or pursuring his/her undergraduate degree, under the age of 23, he/she is eligible for a reduced $10 monthly rate for member contributions.

However, if you do have a steady means of income and can contribute more to help MAS further develop its services and resources, it is most appreciated.

Please note, it is the member's responsibility to update their membership post graduation to the sliding scale rates once he/she are fully employed.

In the event the member chooses not to update, he/she risks impacting their eligibility status for voting and holding office in the organization.

Demographics

MAS is working towards increasing diversity and maximizing our resources within our membership. While these two questions are optional, it helps us measure progress towards makes MAS more diverse in terms of age, ethincity and gender.

Student Status (year in school - high school or undergraduate) School Name Ethnicity Do you consider yourself 2nd + generation (born and raised in the United States) Birth Date (please insure 4-DIGIT BIRTH YEAR IS ACCURATE) / / Gender:

PARENT/Guardian Contact Information (applicants under 18)

If you are under 18 years of age when applying for membership to MAS, please fill in the information below so MAS Operations can reach out to your parent or guardian to consent to your membership.

Parent/Guardian Name Parent/Guardian Phone Parent/Guardian Email

If the event the information above is left blank or incorrect or your parent/guardian does not consent, MAS reserves the right to terminate membership until either consent is received or the member is 18 years old or greater.

Chapter Selection

Please choose the chapter you wish to affiliate yourself with. If you are a new member, we will be reaching out to the chapter leadership and connecting you to them. If there is no chapter in your area, please email Membership[at]MuslimAmericanSociety.org, but choose unaffiliated for now.

Choose a chapter to be a part of:

MEMBERSHIP APPLICATION ACKNOWLEDGMENT

By submitting this form, you acknowledge agreement and acceptance of the mission, vision and values of the Muslim American Society. Submission of the form does not guarantee membership. MAS reserves the right to decline, cancel or revoke membership at any time a person exhibits behavior or actions contrary to our values. As a member, you agree to resolve any dispute pertaining to MAS, its chapters or affiliates through Islamic Arbitration as outlined in MAS' policies and procedures.

Please type your name to indicate your understanding of the acknowledgment statement above.