Bat Mitzvah Club Registration Form - ChabadofScottsdale.org

Address*

Cellular Number

Area Code Phone Number
Age*
Grade
School*
E-mail*
Member's E-mail address that is checked daily
I would like to receive news and updates by email
English Birth Date*

Month Day Year
Time of birth*
Hour Minutes
Family Information
Father's Name*
Fathers Number*

Area Code Phone Number
Mother's Name*
Mothers Number*

Area Code Phone Number
Parent's E-mail* Will receive the confirmation upon submission
Parent's E-mail (if different)
Membership
There is a $125 annual membership fee, which includes all club meetings, supplies and refreshments.
Membership*

$125 USD
Total

$0.00 USD
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card Check

Postal / Zip Code

Country

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BMC Registration Form