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Purim Registration

Purim Registration

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PURIM DINNER REGISTRATION FORM
Wednesday, February 28, 2018 • 6:30pm

First Name:
Last Name:
Address:    
                   City:           
            State:          Zip:
Phone:       
Email:        

Adults: $27 ($32 after February 21)
Children: $16 (ages 3-12) ($19 after February 21)

How many adults?   
How many children?

––––––––––––––––––– Sponsorship –––––––––––––––––––

Check this box to be a sponsor ($180) 

––––––––––––– Payment Information –––––––––––––
To pay by credit card, please complete the following:

Card type:

Name on card:
Card no:          
   Expiration:                              

Enter total amount:
________________________________
To pay by check, please complete:

I will mail a check:
Enter Total Amount:
to Chabad of the Inland Empire
8710 Baker Avenue, Rancho Cucamonga, CA 91730
(909) 949-4553

 


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