CTeen Membership Form for High School Students

Teen Info:

First Name 

Last Name Hebrew Name (if known) 

DOB School 

Grade Entering 

Previous Jewish Education 

Cell   Email  

 

Payment

$95 per Teen (Includes all events besides Trips)

You can pay using your Credit Card or check.

Mail check to the Chabad Center of Sudbury, 100 Horse Pond Road Sudbury, MA 01776

Check


Card Number 

Name on Card 

Amount 

Expiration Date 

CCV