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ב"ה

Bar/Bat Mitzvah Registration

Bar/Bat Mitzvah Child

First Name Last Name
Birth Date

Month Day Year
Time of birth

Day time Night time
Gender

Bar Mitzvah Bat Mitzvah
I can read Hebrew

None at all Somewhat Pretty well
Family info.

Dad Mom
Last Name

Address

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

HomePhone Number

- Area Code Phone Number
Dad Mobile Number

- Area Code Phone Number
Dad's E-mail
Mom Mobile Number

- Area Code Phone Number
Mom's E-mail
Family history
Are they any conversions in the family?*

Yes. Skip to payment info. No
Please specify

Dad's side of the family Mom's side of the family.
Bar/Bat Mitzvah Sunday Classes

$600
Membership*

$770
Total

$0.00

Payment

Credit Card Mail payable check to:

Postal / Zip Code

Country

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Letter in Childrens Torah