USY Membership Form – Highland Park Conservative Temple

2021-2022 HIGHLAND PARK USY Dues Form
Advisor: Mikaela Zirin
Email: mzkarategirl@gmail.com

To become a member of Highland Park USY for the 2021-2022 school year, please fill in the form below and click submit. You will be brought to the payment page where you can submit the USY dues. Dues this year are $50.00. You can also add an optional $6.13 as a donation to Tikkun Olam, the USY Tzedakkah program.

USYer Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

USYer Email *

Home Phone *

USYer's Cell Phone *

Grade *

Birthdate *//

School *

Do you want to register a second USYer? *

Parent Information

Parent 1 Name *

First

Last

Parent 1 Cell Phone *

Parent 1 Email *

Parent 2 Name

First

Last

Parent 2 Cell Phone

Parent 2 Email

Check box to add $6.13 per USYer as a donation to Tikun Olam, the USY Tzedakkah

613 Mitzvah Club

After clicking Submit you will be taken to PayPal where you can enter your credit card information. You do not need a PayPal account, but you can log in to use your account if you have one.

Total

$ 0.00

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