RESERVATIONS First Name Last Name Address City State Zip Code Phone Email New Years Community Dinner Adults $40.00 per adult 1 2 3 4 5 6 7 8 9 0 Child $35.00 per child 1 2 3 4 5 6 7 8 9 0 Co-sponsor (includes 2 tickets) - $180 Sponsor (includes 4 tickets) - $360 High Holiday Services I plan to attend: Please check all that apply. Day 1 Rosh Hashanah September 4/5 Day 2 Rosh Hashanah September 5/6 Yom Kippur September 13/14 Evening Service Morning Service Kol Nidrei Service Morning Service Morning Service Neilah Service Sukkot September 18 Prayer & Kiddush in the Sukkah Simchat Torah September 26 Prayers & Dancing with Torahs Break-fast Buffet Amount Adult Attendees for above services 1 2 3 4 5 6 7 8 9 0 Amount of Children Attendees for above services 0 1 2 3 4 5 6 7 8 9 Adult Names Child Names Help Chabad bring more light to the community with your generous contribution. Please Choose $100 $180 $360 $500 Other $ Please submit your billing information below. No one will be turned away for inability to pay. Confidential fee adjustments may be made by emailing the Rabbi. Card Type Please select MasterCard Visa American Express Discover Card Number Expiration Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 2013 2014 2015 2016 2017 2018 2019 2020 CVV Code Total Amount to Charge Card Please click submit only once. Please wait a few seconds for acknowledgement online that your information was received. We will send you a receipt once your payment has been processed. This page uses 128 bit SSL encryption to keep your data secure.
