ב"ה

Join

I AM A TEEN (this registration is for me)MY TEEN (I am a parent, this registration is for my teen)
Teen's Information
Full Name*
First NameLast Name
E-mail*
Phone Number
Area CodePhone Number

Address

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
Parent's Information
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
$180.00

Payment

Credit Card Check

Postal / Zip Code

Country

100% of the proceeds of this donation or payment benefit the Jewish Discovery Center.
Should be Empty:

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