Bat Mitzvah Club Teen Information Name Email Cell Date of Birth Address Line 1 Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Postal Code Parent/Guardian Information Primary Guardian Name Email Cell Optional Second Guardian Name Email Cell Emergency Information Emergency Contact Cell Tuition & Payment Select a payment planPay the full cost of the program ($360)Two payments, now and November 1, 2023 ($180/payment) How would you like to pay?Credit CardMail Check(s) to 730 Ponce de Leon Place NE, Atlanta, GA 30306 Name on Card Card Number MM YY Code Authnet_Hidden_Fields reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA.
