BNTY MEMBERSHIP APPLICATION 2013-2014          JR_____ SR______
DUES:
Temple Members: $85 ($74 for each additional child)
Non-temple Members: $125 ($115 for each additional child)

*Please make checks payable to BNTY

BNTYite Information:
Name:_________________               Grade:_______           School:_______________
Student Cell Phone:_____________               Student Email:________________________

 

Parent/Guardian 1: Name:________________ Home Phone:_______________
Address:_________________________________________________________________
Email:___________________________________________________________________
Cell Phone:______________________________

 

Parent/Guardian 2: Name:________________ Home Phone:_______________
Address:_________________________________________________________________
Email:___________________________________________________________________
Cell Phone:______________________________

 

Emergency Contact Name:____________________________         Number: _______________

Please inform us of any dietary or medication conditions we should be aware of:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Want to be involved? Chaperone? Be on our YAC committee?
_______________________________________________________________

Want to keep up with BNTY and our BNTY SR board/ BNTY and NFTY Events? Leave us your email!
*Your email will only be shared with the BNTY staff as the email is monitored by our staff only.
____________________________________________________

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