Express Shabbat Dinner Reservations
(through Wednesday, December 6, 2018 11:59 pm)

I wish to reserve space at the Shabbat Dinner:

 

Adults

 

Children

 

 

Please type the name(s) of those who will be attending:

 

Email Address of primary contact:

 

Please charge the following amount for my/our Dinner fees:
($36 adult, $10 child under 12)

 

Amount:

 

 I wish to be a Sponsor
 

 

Credit Card Information:

 

Card Type:

Card Number:
  (Please enter only digits)
Valid Until:

PLEASE NOTE: The name below must match the information on credit card .
First Name:
Middle Name:
Last Name:
Street Address:
 
 
City:
State:
Zip Code:
   
Email:
Please Retype
Email:
Phone: