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Programs Youth TMC - Teen Mitzvah Club

TMC Registration

Daughter's Info
Daughter's Name*
First Name Hebrew Name Last Name
Daughter's E-mail*
Daughter's Birthdate*

Month Day Year
at Hour Minutes

Address*

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

Parent Info
Parent Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
Payment Info
Yearly Fee*

$300
Optional donation to help cover food expenses

$
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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