Purim Seudah and Shabbat Dinner

Your Information

First Name *

Last Name *

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Please be sure to write your FULL street address and apartment number if applicable

Street Address *

State (Primary)

City (Primary)

Postal Code (Primary)

Number of Adults

Number of Children

Names of everyone attending

Event Fee(s)

Regular Price After March 6- $30 per adult | $15 per child (2-12) with $100 family max

Please enter in the number of children/adults who will be attending. If you are attending as a family, choose "Family Price"

Price Per Child (2-12)

$15.00

Price per Adult

$30.00

Family Price

. - $ 100.00

Donations include Event Registration for 1 Family

Donation Options

Total

Authorize.net (Credit Card)

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My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

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Postal Code *