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Enter the Zone. Where Judaism is Fun!

ב"ה

Birthday Club

Mother's Name*

First Name Last Name
Father's Name

First Name Last Name
Primary E-mail*

Address*

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

Child's Name*

Please fill out a separate form for each child.
Child's Jewish Name
Phone Number

Area Code Phone Number
Secular Birth Date*

Month Day Year
Approximate Time of Birth*

Hour Minutes
Should be Empty:

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