Join

I AM A TEEN (this registration is for me)MY TEEN (I am a parent, this registration is for my teen)

Full Name*

First NameLast Name

E-mail*

Phone Number

Area CodePhone Number

Address

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

High School

Graduation Year

Birthday

MonthDayYear

What is your preferred method of communication?

FBEmailText MessageAll of the above

Two friends I would like to refer to CTeen (optional):

Friend 1

Friend 2

Size for cTeen tshirt:

Is your mom or dad Jewish?

MomDadBoth

Mother's Name

First NameLast Name

Mother's E-mail

Mother's Phone Number

Area CodePhone Number

Father's Name

First NameLast Name

Father's E-mail

Father's Phone Number

Area CodePhone Number

$180 Membership - club membership includes cool gear, monthly club meetups, learning program, supplies, humanitarian projects, dinners and 20% off regional trips.

Registration*

$180

I would like to make a donation to sponsor another teen:

$

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Teen's Information

Parent's Information