« Back to Chabad of Western Michigan

Welcome!

CTeen Grand Rapids

Committed to Enriching the Lives of Teens and the Community

For Jewish HIgh School Teens in Western MIchigan

ב"ה

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
JewishConverted
Payment options
Choose your payment plan
Full Membership Fee $75
Total
$0.00

Payment

Credit Card eCheck

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.