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CTeen Registration

Student Information:

Student Name

  Student Phone
Student Email   Age
Grade   School
Parents' Names
Parents' Phone
Referred by      
Payment Information
Please charge my card: $250 CTeen Membership
Trips may be subject to additional fees
$10 Purim Member Price


$25 CTeen Individual Event

Card Type
Card Number
Expiration Date
Billing Address
Billing City/State/Zip/