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Bat Mitzvah Club Registration Form

BMC Registration Form
Member's Information
Full Name*
First NameLast Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code

Cellular Number
Area CodePhone 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*
MonthDayYear
Family Information
Father's Name*
Fathers Number*
Area CodePhone Number
Mother's Name*
Mothers Number*
Area CodePhone Number
Parent's E-mail
Parent's E-mail (if different)
Membership
There is a $100 membership fee (or $15 per class), which includes all club meetings, supplies and refreshments.
Year Membership?
YesNo
Pay per class$15 per class
November 24December 15January 12February 2March 1March 22April 26May 17
Total
$0.00 USD

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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Bat Mitzvah Club