Bar Mitzvah Club Registration Form - Chabad-Lubavitch of Winnipeg

בס"ד

Please carefully complete this form, then click submit.

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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 $100)

Preferred Payment Method:

Name on Credit Card:
Credit Card Number:
Code:
Expiry Date:

Other
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