Printed from

Cteen Event RSVP

Cteen Event RSVP

Cteen Event Registration
First Name:
Last Name:
We're old friends - You have my information! (skip next section)
Personal Information
City: State:
Phone #: Zip:
Teen Info
Name of teen: Grade:
Name of teen: Grade:
Name of teen: Grade:
Event Details

Learn from an expert Israeli Self  Defense instructor
what to do in any situation. Falafel  dinner served!
Cover $10.

I'd like to make a payment in the amount of: $

Comments/Additional Info (This space may be used to RSVP for additional guests): Need transportation help? Here's the place to let us know!

Payment Type
I'd like to pay by check*. Please print out this page, or download a PDF and mail. Write "CTeen Event" under Comments.
  *Please make checks out to 'Chabad of Laguna Niguel'.
Mail to:
Chabad of Laguna Niguel
27631 La Paz Rd #D
Laguna Niguel, CA 92677
I'd like to pay by credit card using the secure form below.
(Our secure form uses 128 Bit SSL Encryption for your protection)
I'd like to pay by credit card on file.

Last 4 digits of card: (Scroll to the bottom of the page and click "submit".)

Billing Information
Check box if Billing & Personal Information are the same.
First Name:
Last Name:
Billing Address:
State: Zip:
Phone No:
Payment Information
Card Type:
Name on Card:
Card No:
CVV Security Code: What's This?
Expiration Date:
Total Amount: $

Secure This page uses 128 bit SSL encryption to keep your data secure.