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BMC Registration

BMC Registration

BMC Registration

Bat Mitzvah Girl Profile
First Name
Last Name
Hebrew Name (if known)
DOB
School
Grade Entering (Sept. 2015)
Phone
Email
Bat Mitzvah Girl #2 Profile
First Name
Last Name
Hebrew Name (if known)
DOB
School
Grade Entering (Sept. 2015)
Phone
Email

 

Parent Information
Father's Name
Mother's Name
Address
City, State, Zip
Phone
Cell Phone Father
Father's E-mail address
Cell Phone Mother
Mother's E-mail Address

   

Are both parents Jewish? Yes No

To your recollection have there been any conversions or adoptions in the family? No Yes
If yes please explain :

 

Payment Options

Annual membership fee: $180.00, Please charge payments

Name on Card:
Card Type
Card Number
Exp. Date
CCV Number (on back of card)
Comments (optional)


We look forward to a wonderful and exciting year of learning and growth!

~~
For more information, or if needed to discuss anything,
please call Esther at 847-808-7770 or 847-893-0988
or email: esther@nwsChabad.org

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