Name: _________________________________________________________________
            First                                        Middle Initial             Last

E-mail Address: _________________________________________________________

Phone Number (optional): ________________________________________________

I am joining the MSA because:

___ I’d like to learn from the group
___ I’d like to make friends
___ I’d like to help out
___ All of the above

I can or would like to help the MSA in the following area(s). Please check as many as you like:  

___ Teaching
___ Public / Media Relations
___ Giving or Hosting Halaqas
___ Writing or reporting to Newsletter
___ Organizing Activities
___ Other please explain:
       ____________________________________________________________________
       ____________________________________________________________________

Please list below your availability times throughout the week. This will be the time you consider yourself free and willing to help the MSA in any given event.  

Sun: _______________________________________________________
Mon: ______________________________________________________
Tues: ______________________________________________________
Wed: ______________________________________________________
Thurs: _____________________________________________________
Fri: ________________________________________________________
Sat: _______________________________________________________