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ב"ה

A Word from the Rabbi 2014

Bat Mitzvah Club Registration

Girl's name*

First Name Last Name
Birth Date*

Month Day Year
Mother's name

First Name Last Name
Is Mother Jewish?

Yes No Converted to Judaism
If converted, please explain*
Father's name

First Name Last Name
Is Father Jewish?

Yes No Converted to Judaism
If converted, please explain*
E-mail*
Phone Number*

Area Code Phone Number
BMC Cover

$460
Total

$0.00

Address

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

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

*As a member of Chabad International, Chabad of Scarsdale can only recognize conversions performed to the full extent of Halachah, and/or conversions recognized by the Chief Rabbinate of Israel. Thank you for understanding.
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