Become A member | London Muslim Mosque

Membership Application

First & Last Name *

Middle Name *

Alternate Number *

Email *

Send me notices by e-mail: *

(LMM urges potential members to select yes. E-mails reduce paper waste, help the environment, minimize administrative work, and substantially reduce costs for the mosque)

LMM Newsletter *

(Select Yes if you would like to receive our newsletter as well as updates and announcements from the Mosque)

Adrees *

City *

State *

Postal code: *

Subject *

I declare that I am at least 18 years of age and that I am in full agreement with the Mosque Constitution *

I commit to furthering the Objects of the Mosque *

agree with provisions in the Letters Patent, By-laws and policies of the Mosque *

I am a resident of London for a minimum of 6 months at the time of my membership application and I intend to remain so during the term of membership *

I accept the Statement of Faith adopted by the Mosque *

I agree to abide by Quranic, moral, spiritual, and doctrinal standards of Islam *

I recognize the leadership of the Imam in religious matters *

I do not have any criminal records of any kind at the time of application *

I'm not member or have been member of, involved with in any way, any organization or group which has been designated as a listed entity by the government of Canada pursuant to Canada’s anti-terrorism legislation that may be in place *

I understand that my application must be approved by the board before I become a member *

I understand that my membership shall commence after approval by the board *

I understand that membership fees shall be regarded as donations (where permitted by the Income Tax Act and Canada Revenue Agency’s policies) *

understand that failure to pay my membership fee will result in suspension of my membership *

First Reference *

Please provide references who are currently members of LMM in good standing:

Second Reference *

Please provide references who are currently members of LMM in good standing:

I understand that the mosque might use and disclose the information in this application form for the purposes above *

The information collected in this application form is required to determine your eligibility for membership and to assist
the Board of Directors in providing programs and benefits to members. The information will be retained in the Membership
Record identified in the Mosque Constitution. Use and disclosure of this information will be done according to the Mosque
Privacy Policy. Under the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Access to
Information Act, individuals have the right to protection of, access to, and correction of their personal information

I confirm that I have read and understood the London Muslim Mosque By-laws *

The information collected in this application form is required to determine your eligibility for membership and to assist
the Board of Directors in providing programs and benefits to members. The information will be retained in the Membership
Record identified in the Mosque Constitution. Use and disclosure of this information will be done according to the Mosque
Privacy Policy. Under the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Access to
Information Act, individuals have the right to protection of, access to, and correction of their personal information

understand that memberships start on January 1 and end on December 31 and that membership fees are not prorated based on when I apply for membership *

I understand and agree that donation receipts will be provided after the end of each calendar year *

Signature Date *

Signature *

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