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 State ZIP Code

Phone*

USY Bowling Night - Saturday, September 23 7:30-10 pm - USY Member

Price: $26.00

USY Bowling Night - Saturday, September 23 7:30-10 pm - Non Member

Price: $30.00

USY Sushi in the Sukkah - Tuesday, October 3 6:30-8:30 pm - USY Member

Price: $13.00

USY Sushi in the Sukkah - Tuesday, October 3 6:30-8:30 pm - Non Member

Price: $18.00

Shabbat Club only - October 6 - USY Member

Price: $15.00

Shabbat Club only - October 6 - Non Member

Price: $18.00

Shabbat Club only - November 3 - USY Member

Price: $15.00

Shabbat Club only - November 3 - Non Member

Price: $18.00

Machar Kadima Opening Event - Sunday, September 10 - YD Member

Price: $10.00

Machar Kadima Opening Event - Sunday, September 10 - Non Member

Price: $12.00

Total

Total

Payment Method*

I will send a check to the CBI office

Credit Card (Visa or MasterCard)

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total