JWC Siddur Party

If you are registering your daughter list the name in the notes section

Your Information

First Name *

Last Name *

Email Address *

Phone *

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)

Early Bird Rate Expires April 21. If you are a JWC Member please use that price set. If your guest is not a member please use the non member price set for them

JWC Price per person

Non JWC Member Price

Non JWC Member Price (Includes daughters) - $ 72.00

Non JWC Member Price 2 Participants - $ 144.00

Non JWC Member 3 Participants - $ 216.00

- none -

Other Donation Amount

Total

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

CHABAD OF STAMFORD - JEWISH CENTER FOR LIFE AND LEARNING