Printed fromChabadBronx.org

ב"ה

Youth Bat Mitzvah Club

Celebrate your Bar/Bat Mitzvah at Chabad!

Father's Name*

First Name Last Name
Mother's Name*

First Name Last Name
Child's Name*

First Name Last Name
Best contact email*
Best contact phone Number*

Area Code Phone Number
I want to*

reserve a Bar Mitzvah reserve a Bat Mitzvah
Date:*

Month Day Year
at Hour Minutes
Deposit*

$100

Payment*

Credit Card

Credit Card Type
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

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

Programs