Convert Care Sign Up-Form

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Below information will be used by Convert Care and will NOT be displayed on our Website!

Your Full Name

Email address

Contact number

How long has your group/organisation been running?

Do you have scholar or imam advisors, if so please name all involved:

Do you follow a particular school of thought?

Do you have a convert to Islam involved in your management? If so please provide their name and their position/responsibilities

Below information will be displayed on Convert Care Website so users can contact you!

Organisation or Mosque name

Are you a Mosque?

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Are you a Registered Charity?

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Lead Contact name

Email address

Contact number

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Search Location

Do you provide support for men and for women?
Tick all that applies

Prayer facilities for women?

Does your organisation/mosque provide support/ advice by means of;

Description about your organisation or Mosque. E.g. About us and what we do?

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Youtube Link

Website Link

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