Considering Becoming A Muslim? Please complete the questionnaire below. Every question is essential and your answers will help us assist you in making an informed decision. Name(Required) Mr.Mrs.MissMs.Dr.Prof.Rev.Bro.Sis. Prefix First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Enter Email Confirm Email Phone Number(Required)Preferred Method of Contact(Required)EmailPhoneNo PreferenceTell Us About YourselfWhat's Your Birthday?(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is Your Current Faith?(Required)N/AChristianOtherHave you ever attended a school or classes about your current faith?(Required)N/AYesNoNot ReallyHow would you describe your education?(Required)High School or GEDSome CollegeBachelorsMastersPhDOther CertificationDid not finish High SchoolWhat Do You Do for Work?(Required)Not Working Right NowBusiness OwnerEntrepreneurEmployedWhat type of Business do you own?(Required)What field are you working as an Entrepreneur?(Required)Please explainWhere are you currently employed?(Required)Please share the name of the company / companies where you are employedWhat current certifications do you have?(Required)Tell Us About Your FamilyWhat is your relationship status?(Required)SingleMarriedEngagedDivorcedSeparatedWidowedIn a relationshipIt's ComplicatedDo you want to get married?(Required)Yes, I am seeking a Muslim SpouseNo, I am not interested in marriage right nowNot sureWould you like to join our Matrimony Mailing List?(Required)Absolutely! Send me the detailsNo, not interestedWhat is the faith of your Spouse?(Required)N/AMuslimChristianOtherIs your Spouse becoming a Muslim as well?(Required)N/ANoYesNot sureDo you have any children?(Required)No, I do not have any childrenYes, I have children with me at homeYes I have children, but they do not live with meHow many children live with you?(Required)None12345 or moreHow old are your children?(Required)I'm PregnantBetween age 0 to 3 yearsBetween ages 4 to 10 yearsBetween ages 12 to 16 years18 years or OlderChildren of all ages but no teenagersAll Adult ChildrenTell Us About Your Interest in Al-IslamHow did you hear about Masjid al-Faatir?(Required)Google SearchYelp!Surfing the InternetA FriendA RelativeMy BoyfriendMy GirlfriendMy FianceMy SpouseOtherDo they attend Masjid al-Faatir?(Required)YesNoNot SureBriefly tell us why you are interested in al-Islam?(Required)What has kept you from converting sooner?What questions would you like answered about al-Islam?Do you think becoming a Muslim will improve your life? Please explain.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
