Youth Activity Payment Form Youth Activity Payment Form "*" indicates required fields Parent's Name* First Last Email* Enter Email Confirm Email Child's Name* First Last If you are registering multiple children please list their names and the event they would like to attend.Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*USY Bowling Night - Saturday, September 23 7:30-10 pm - USY Member Quantity Price: $26.00 Quantity USY Bowling Night - Saturday, September 23 7:30-10 pm - Non Member Quantity Price: $30.00 Quantity USY Sushi in the Sukkah - Tuesday, October 3 6:30-8:30 pm - USY Member Quantity Price: $13.00 Quantity USY Sushi in the Sukkah - Tuesday, October 3 6:30-8:30 pm - Non Member Quantity Price: $18.00 Quantity Shabbat Club only - October 6 - USY Member Quantity Price: $15.00 Quantity Shabbat Club only - October 6 - Non Member Quantity Price: $18.00 Quantity Shabbat Club only - November 3 - USY Member Quantity Price: $15.00 Quantity Shabbat Club only - November 3 - Non Member Quantity Price: $18.00 Quantity Machar Kadima Opening Event - Sunday, September 10 - YD Member Quantity Price: $10.00 Quantity Machar Kadima Opening Event - Sunday, September 10 - Non Member Quantity Price: $12.00 Quantity Total Payment InformationTotal Payment Method* I will send a check to the CBI office Credit Card (Visa or MasterCard) Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Total