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Programs Bat Mitzvah Academy

Sign Up Form

Name of Child

First Name Last Name
Birth Date

Month Day Year
Time of Birth

Hour Minutes

Address

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

E-mail*
Cost:* $750 plus $25 Book Fee

$775
Total

$0.00

Payment

Credit Card Other

Should be Empty:

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