CTEEN NEW YORK SHABBATON!

  Dates for 2015 - Feb. 26-March 1
    Join us to have a blast of a time! 

 

 

 Teen First Name:


Teen Last Name

Teen Email Address:

Teen Mobile Number:

 

 Teen Address:

 

 

 

 

 

 

 

 


 

 

 City                                                   

    


 

 

 

 

 

 School                            Grade

          

 

 Sweatshirt Size: 

 

 

 

Parent First Name:

 

 

 

 

 

 

 

 

 Parent Last Name:

 

 

 

 

 

 

 

 

Parent Email Address:

 

 Gender            Birthday (1/1/1923)
     

 

 

 

 

 

 Parent Mobile Number:

 

   

Did you go to a CTEEN Shabbaton Before?

 

 

 

 

 

 

Total Due (including flights): 

Before Dec 19 (12pm-noon):  $399.00
After    Dec 19 (12pm-noon):  $499.00 

 

Card Number:

Expiration Date:

CCV:

 

Name on Card:

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City:

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ZIP:

Comments/Notes: