Printed from ChabadPaloAlto.com

Bat Mitzvah Club

Bat Mitzvah Club


Child Information     
Last Name 
First Name 
Hebrew Name 
Date of Birth 
Age 
Child's Email 
 
What school does your child attend?  Grade entering: 
 
Child 2 Information     
Last Name 
First Name 
Hebrew Name 
Date of Birth 
Age 
Child's Email 
 
What school does your child attend?  Grade entering: 
 
     

Parent Information

   
Mother's Name 
Home Phone 

Work Phone 

Cell Phone 
Email 
Occupation 
Address 
City 
State 
Zip 
   
Father's Name 
Home Phone 
Work Phone 
Cell Phone 
Email 
Occupation 
Address (if different from above) 
City 
State 
Zip 
   
     
I heard about BMC from: 
     
BMC Payment    
The cost for BMC is $136.00 per year. 
Additional Donation:  54  72  180  Other: 
Credit Card Information
First Name      Last Name
Credit Card Number Billing Address
City State, Zip  
Charge Amount Exp Date     
CVV

 

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