בס"ד

Bar Mitzvah Club Crowd Logo 75.jpgBar Mitzvah Club
REGISTRATION FORM
2017/8 - 5778

Please carefully complete this form, then click submit.


SecureThis page uses 128 bit SSL encryption to keep your data secure.

Member's Information

Family Name:
English Name:
Hebrew Name:
Date of Birth:
Jewish Date of Birth online date calculator
School:
Grade:

 
Address:
City:
Postal Code:
Member's E-mail:

Parent's Information

Member is in care of:
   
Father's English Name:
Father's Hebrew Name:
Father is:
Father's E-Mail:
 
Mother's English Name:
Mother's Hebrew Name:
Mother is:
Mother's E-Mail:
 

Bar Mitzvah Celebration

If you have plans for the celebration your Bar Mitzvah, please BREIFLY describe them.
If you do not, we would be happy to discuss various options with you.

 

Payment Information (cost is $150)

 
Preferred Payment Method:
 
Name on Credit Card:
Credit Card Number:
Code:
Expiry Date:
 

Other

Please enter any comments you have below: