High Holiday Reservations & Sponsorship Form Personal Information: Title: Please Select Mr. and Mrs. Mr. Mrs. Ms. Miss Dr. Prof. Hon. Last Name: First Name: Email: Additional guest in your party: We're old friends -You have my information!(skip next section) Address: City: State: Zip: Phone No: Simchat Torah Saturday Night Live, October 10 Adult 0 1 2 3 4 5 6 7 8 9 Child (2-11) 0 1 2 3 4 5 6 7 8 9 Sunday, October 11 Adult 0 1 2 3 4 5 6 7 8 9 Child (2-11) 0 1 2 3 4 5 6 7 8 9 Donations & Sponsorships Sponsor $180 Co-Sponsor $100 I would like to dedicate 0 1 2 3 4 5 6 7 8 9 prayer book/s for $36 each Other amount In honor memory of: Payment Information: Card Type: Please select MasterCard Visa American Express Discover Name on Card: Card No: CVV Security Code: What's This? Expiration Date: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2009 2010 2011 2012 2013 2014 2015 2015 2016 1017 2018 2019 2020 Total Amount: Comments: Enter any extra details here. I will be mailing a check to Chabad Jewish Community Center, 3579 Arlington Ave., Suite 100, Riverside, CA 92506 I would like to be added to the mailing list Please click only once on the "Submit" button and wait a few seconds for acknowledgement online that your information was received. This page uses 128 bit SSL encryption to keep your data secure.