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Registration

Cteen Cafe’:
October 12 | November 9 | December 14 | January 11
March 8 | April 12 | Cteen Cafe’ Shabbat Dinner: May 15
Time 5:00-7:00pm (times may vary)

Program fee $225 (Includes all Cteen Cafe’ events and NYC Trip discounts)
Early bird discount by September 30, 2025: $180
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Option 1Option 2Option 3
Parent's Information
Father's Full Name*
First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number
Mother's Full Name
First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number

Address*

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

Teen Information
Full Name*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
E-mail*
Phone Number*

Address*

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

School*
Grade*
Best Contact*
Questions/Comments
Yes, I’d like to sponsor a Cteen Cafe’:

$360
Total

$180.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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