Connection Point Payment Form

Membership Office
781 East New York Ave.
Brooklyn, NY 11203
(718) 774-6000



This form only works with English letters.  For Hebrew please call the office.

First Name:*Last Name:*
Email:* Telephone:


City:*Country:*


Choose Card:*


 



Card Number:*Name on Card:*


CVS #:*Expiration Date:*


Notes:

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Please enter the following code into the box provided:





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