Teen Information
First Name   Home Phone
Last Name   Cell
Hebrew Name   Date of Birth
Mailing Address   School
City/State/Zip   Grade
Email      
Best way to contact me is: Email Phone Text Facebook
     
Parent Information
Father's Name   Mother's Name
Cell   Cell
Email   Email

Payment Options

I would like to pay $10/event

I will mail in a check for $75
Mail to:
Chabad House/ CTeen
660 Merrimon Avenue, Suite C
Asheville, NC 28804-3564

I will pay $75 using the online form below
Name on Card   Charge Amount
Card Type   Card #
Exp. Date   CVV Code 3 digits on back of card

Become A Member!

Member Benefits
*Covers most events, discounts for larger event
check mark.jpg Free CTeen T-shirt!
check mark.jpg$25 off the International CTeen Shabbaton!
check mark.jpgMembership certificate!
check mark.jpgAnd much more….

Yes, I’d like to join as a Member for $75. (Covers most events, discounts for larger events)

Yes, I'd like to sponsor an event for $180.

Permission is hereby given for Chabad of Asheville CTeen to use in promoting CTeen and in other ventures directly relating to CTeen/Chabad (i) digital, photographic, video, and audio images or likenesses of teen member; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by the teen member or originating from CTeen or from a CTeen related activity.