Ramadan:

Countdown Ended

Registration Form

Membership Registration

Join the Community Funeral Support Fund — one family membership for £300 a year, run by QUBA Masjid & Education Centre (Registered Charity 1189923).

Main Member

The primary applicant for this family membership.

Full name *

Email *

Mobile

Date of birth *

Post code *

Address *

National Insurance number *

Spouse

Add your spouse to the membership, if applicable.

I want to add a spouse

Children / Dependants

Add unmarried children and eligible dependants. You can add up to 10.

GP Details

Your registered doctor's surgery (optional).

Name of GP

Practice telephone

Practice name and address

Practice post code

Consent & Declaration

I have read and agree to the declaration and privacy notice.

Full name (signature) *

Date *

Membership is £300 a year, payable by direct debit, bank transfer, or in person at QUBA Masjid. Bank transfer: Quba Masjid & Education Centre · Account 71864610 · Sort code 40-23-26. Cover begins three months after your contribution.

A unique Membership ID will be shown after you submit — please save it. You'll need it to update your membership later.