B'nai Mitzvah Submission Form

B'nai Mitzvah Submission Form
Name of person submitting form *

First Name Last Name
Email of person submitting form *
Phone Number of person submitting form *

Area Code Phone Number
Bar/Bat Mitzvah 1 *

First Name Middle Name Last Name
Bar/Bat Mitzvah 2 (if applicable)

First Name Middle Name Last Name
Date of Bar/Bat/B'nai Mitzvah *

Month Day Year
Parent 1

First Name Last Name
Parent 2

First Name Last Name
Grandparent 1

First Name Last Name
Grandparent 2

First Name Last Name
Grandparent 3

First Name Last Name
Grandparent 4

First Name Last Name
Mitzvah Project(s)
Tell us about the service project the bar/bat mitzvah is working on for their special milestone.
Additional Family Members
If applicable
Notes/Additional Information
If applicable
Photo

Upload a File
Providing a photo is optional, but we'd love to have one to include in our communications to the congregation! Cancel of
By checking the box below, you give us permission to release the information and pictures above in the congregation-wide eblasts and Beineinu newsletter. For more information about our eblasts and newsletter, contact the Marketing Coordinator and Graphic Designer: Lauren Dube (404.603.5745; ldube@aasynagogue.org).
Do you grant permission? *

Yes, I grant permission
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