Bar/Bat Mitzvah Academy Registration

Bar/Bat Mitzvah Club Registration

Name:*
First and Last Name
Hebrew Name:*
First and Last Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
MaleFemale
School*
Grade*

Title
Name:*
First and Last Name
Home Phone Number:*
Mobile Number:*
Work Phone Number:*
Email Address:*

Title
Name:*
First and Last Name
Home Phone Number:*
Mobile Number*

Area CodePhone Number
Work Number*

Area CodePhone Number
E-mail*

Marriage Status:*
Synagogue Affiliation:*
Have there been any adoptions/conversions? If yes, please explain:*

Bar Mitzvah ClubBat Mitzvah Club
Tuition:$540 | Members $450

PAYMENT:*

Tuition$540.00CAD

Member$450.00CAD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: