Lunches - ShulCenter.org

Cteen House Lunches Sign Up:
Teen's Name*

First Name Last Name
Phone Number

Area Code Phone Number
E-mail
School & Grade
By clicking the box below I certify that I have read and agree to the following statement.*

I acknowledge that my parents have to e-mail and/or call the Nicolet office to give permission for me to attend these events.
Payment:

Sign up weekly monthly or yearly

(Not likely, but lunches are subject to change without lonely)
Payment Amount

$2$18$180

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

Donation Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%
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