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Bar Mitzvah Club Registration

Bar Mitzvah Club Registration

General Information
Name Hebrew Name
Birthday Time of Day
Grade School
Address Phone
City, State, Zip Email
 
Parents Information
Mothers Name Fathers Name
Mothers Email Fathers Email
 
Emergency Information
Emergency Contact Phone
 
Payment Details - Membership is $105 for whole season
Membership Type Card Number
Expiration Date CVV
Billing Zip Comments

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