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Youth Programs Bat Mitzvah Club

Bat/Bar Mitzvah Club Registration

Child's Name*

First Name Last Name
Parent Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number
E-mail*
Program*

Bat Mitzvah Club Bar Mitzvah Club
Amount*

$95

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Should be Empty:

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