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Register for the Chabad Bat Mitzvah Club 2012/13

Register for the Chabad Bat Mitzvah Club 2012/13

Please fill out the form below to reserve your spot!

Bat Mitzvah Girl Information

  
First Name
Last Name
Hebrew Name
Email
Date of Birth  
Time of Birth
School
   
   

Bat Mitzvah Girl Family Information

   
Home Address
City, Province
Postal Code
Home Phone
Father's Name
Father's Hebrew Name
Father's Email
Father's Cell
Mother's Name
Mother's Hebrew Name
Mother's Email
Mother's Cell
Marital Status
   
   

Credit Card Information

   
Card Type
Name on Card
Card Number
Expiration Date
CVV Code
   
 Card will be charged a $100 non-refundable registration fee upon submission. The balance of $650 will be charged on October 15, 2012.
   

Comments and notes 

 

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