מתוך האתרDeadsea-chabad.com

ב"ה

Bar/Bat Mitzvah

Registration Form

Registration Form for Bar/bat Mitzva at the Masada
Please complete the attached form and we will be in touch with you as soon as possible.
Bar Mitzva child's name*
Bat Mitzvah child's name
family name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*
Photocopy of one of the parents' ID card*
I would like to receive news and updates by email
Birth Date*

Month Day Year
Click toHebrew Birth Date (if known) edit
How would you define yourself?

ObservantTraditionalSecular
Will the Bar Mitzvah boy be reading from the Torah?

YesNo
Date of visit to the masada*

Month Day Year
Preferred time of services*
Hour Minutes
Name of contact person
amount of people participating
Telephone Number*

Area Code Phone Number
Cell phone Number*

Area Code Phone Number
The bar mitzvah boy's phone
Referred By
Comments
Should be Empty:

This page uses TLS encryption to keep your data secure.