USY Registration for non-Temple member – Highland Park Conservative Temple

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? *

Yes
No

Name *

First

Last

USYer Email *

USYer Cell Phone *

Grade *

Birthdate *//

School *

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

Payment

USY fee for non-Temple members is $50 per child *

One child – $ 50.00
Two children – $ 100.00

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