Cteen Annual Registration School Year 2022-23 Membership entitles CTeens to to join monthly meetings and events at a reduced rate, and comes with other member benefits, like leadership roles, and CTeen apparel. Annual Fee: $180. Monthly Events will require a nominal fee for the cost of that event. Teen's Name Gender Select Male Female Hebrew Name Date of Birth Last Name School Address Grade Select Eighth Ninth Tenth Eleventh Twelfth City, Zip & State Hebrew Birthday Teen's Cell Synagogue Teen's Email Biological Mother Select Is Jewish Is Not Jewish Emergency Contact Emergency Contact Phone Mother's Name Father's Name Mother's Phone Father's Phone Mother's Email Father's Email Payment Method Select Visa Mastercard American Express Check is in the mail Card Number Expiration Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 CVV Code Cardholder's Name Billing Zip Total Amount ($180) Comments Check can be mailed to Chabad of South Orlando • 7347 W Sand Lake Road • Orlando, FL 32819
