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CTeen Registration
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Student Information: |
Student Name
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Student Phone |
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Student Email |
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Age |
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Grade |
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School |
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Parents' Names |
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Parents' Phone |
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Referred by |
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Payment Information |
Please charge my card: |
$250 CTeen Membership
Trips may be subject to additional fees
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$10 Purim Member Price
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$25 CTeen Individual Event
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Card Type |
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Card Number |
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Expiration Date |
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CVV |
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Billing Address |
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Billing City/State/Zip/ |
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