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BMC Register

BMC Register

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Register Online

Student Information

First Name

 

Last Name

Jewish Name

 

DOB

Street Address

  City
State   Zip
Home Phone      
Do you like being in a leadership position  
What are some things you hope the BMC will offer?  
Which of these do you enjoy most?  
(To make multiple selections hold down the shift key)
Parent Information
Mother's Name   Father's Name
Hebrew Name   Hebrew Name
Mother's Work   Father's Work
Mother's Cell   Father's Cell
Mother's EMail   Father's EMail
Payment & Fees:

Membership Fee:

$120 includes all sessions, supplies and fees.
I will be paying by: Credit Card Check
Amount:      
Card Type   Card Number
Expiration Date   CVV

Parent's Signature:

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