Persian Shabbat Dinner

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

Program Fee

Please enter in the NUMBER OF of people who will be joining, including both children and adults.

Adult Price

$25.00

Child Price (Ages 2-14)

$18.00

Family Price (Immediate members only)

$100.00

Sponsorship Options (includes 1 family)

Total

Authorize.net (Credit Card)

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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 *