Foundation Khadimou Rassoul North America Membership Pledge Form:

	First Name	:
	Last Name	:
	Address:	:	Please enter your Full Address: Including city and state
	TelePhone:	:
	Email:	:

	Monthly Pledge Amount:	:	$10.00 $30.00 $50.00 $90.00 Other:

	In the Form of:	:	Check Direct Deposit Or
By Signing this form, I, , am commited to give the amount indicated above in the Chosen form. I also do acknowledge that any amount given to the Foundation Khadimou Rassoul North America can be used as tax deductible. May Allah reward you for your generosity.