Shabbat Dinner On-Line Registration 
 
Friday, January 31st 2020 at 6pm
 

Full Name:

Telephone Number:

Email Address:

Number of adults attending:

Number of children attending:
   
 

RATES:

 

 $10 per child over 3 
  $16 per adult
  $45 Family Rate
  $180 Chai Sponsor

  Method of Payment:

 

Amount:
  I'll send cash to the office
  I'll send a check to the office
   Credit Card

If you are paying with credit card, please fill out the following:

  
   

Amount:

Card Type:

Name on card:

Address:

City, State, Zip:

Credit Card number:

Expiration Date:

CVV code: