Bat Mitzvah Club Registration

Address*

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
E-mail*
Payment
E-mail
Registration Fee*

$490
Donation to Chabad help further jewish education

$50.00$75.00$100.00$180.00$500.00$1000.00$1800.00
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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