Bat Mitzvah Club Register online at

Girls Name*

First Name Last Name
Hebrew Name*
Birth Date* So we can calculate your Hebrew birthday

Day Month Year
at Hour Minutes
Girls Cell*

Area Code Phone Number
Girls E-mail*
School*
Grade entering*

Address*

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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