Registration - Moon Sighting UK

The following membership details (for adults only) are required for identifying observation reports and for sending monthly moon sighting alert messages. The details will be kept strictly confidential on our secure server and may not be forwarded to any third parties. The red asterix (*) shows mandatory input. Additional details are shown under the tooltip (?) for individual input.

Personal Information
Are you a Muslim?:
Yes No
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Title:
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First Name:
Surname:
Known As:
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Gender:
Male Female
Date of Birth:
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yyyy-mm-dd (click on title for past year/month options)
Language:
Arabic Bengali English Urdu Other
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Address/Street:
Area:
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Town:
County/State:
UK Region:
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Country:
Postcode/Zip:

Qualification/Profession
Secular:
Islamic:
Occupation:
Employer:

Contacts/Alerts
Telephone Day:
Telephone Eve:
Mobile/Cell:
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example: +447831534701
Email:
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Work Email/Skype:
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Alert Type:
Email Sms WhatsApp
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Are you a representative?
No Yes
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Representative:
If you are completing the above details on behalf of someone else, please ensure you have obtained their prior consent and provide your own contact details below.
Name:
Email:
Mobile:

Miscellaneous
Referrer:
Family/Friends Mosque Newspaper Radio/Tv Other
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*Comments:
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Please state why you wish to join this ICOUK / Moon Sighting UK website (and any 'Other' additional information).
Photo Upload:
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File-size of photo must be between 10 KB and 5 MB (JPG)
Username:
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Username/Password required to update your profile and to send observation reports
Password:
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Confirm:
Anonymous
No Yes
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Are there any special circumstances where your name should be hidden from the website membership list?

Anonymous Membership
Please tick [✔] the option(s) below that applies to you.
I do not wish others to know about my interest in moon sighting because I am a:

Masjid Imam Masjid Trustee Committee Member Media Reporter Student of knowledge Other (Specify)
If other:
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Supporting Doc:
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Upload scan of supporting documentation for anonymous membership (Image: JPG or PNG)

Declaration
Privacy Policy:
Please tick this box to confirm you have read our Privacy Policy
I believe the information provided above is accurate to the best of my knowledge and belief.
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Membership Registration Form