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CTeen Grand Rapids

Committed to Enriching the Lives of Teens and the Community

For Jewish HIgh School Teens in Western MIchigan

Register to be a Member

Cteen Membership Fee: $75/Year * Membership does not include Shabbatons and Trips *
Teen Information
Full Name
First NameLast Name

Address

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

Cell Phone
Area CodePhone Number
E-mail
Birth Date
MonthDayYear
Age
Grade
School
Parent Information
Mother's Name
First NameLast Name
Father's Name
First NameLast Name
Mother's E-mail
Father's E-mail
Mother's Number
Area CodePhone Number
Father's Number
Area CodePhone Number
Marital Status
MarriedDivorced
Mother isCheck all that apply
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Full Membership Fee $75
Total
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