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