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Mom & Tot Shabbat Circle

Registration
Full Name*
First Name Last Name
E-mail*
I would like to receive news and updates by email
Phone Number*

Area Code Phone Number
Name of your child*
Age of your child*
Child's birthday

Month Day Year
Optional Donation

$18$36$54$72$180$36
Total

$0.00 CAD

Payment

Credit Card

We accept Visa, MasterCard
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

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