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Bar Mitzvah Club

Student Full Name*
First Name Last Name
Personal Email*
Date of Birth Example: 01/02/2001

Month Day Year
School of child * Example: JPS
Grad Year* Example: 2023
Date of Bar Mitzvah* Example: 2023
I am*

Jewish and want to get involvedNot Jewish but think you guys are cool!

Permanent Address*

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

PARENTS:
Full Name*
First Name Last Name
Mobile*
E-mail

Address

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

Price per child £180*

£180.00
100% of the proceeds of this donation or payment benefit Chabad of West Hampstead
Total

£0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Paypal

Postal / Zip Code

Country

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