Reservations Purim in Africa
Monday, March 9, 2009 @ 7:00 PM


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In Advance Reservervations
(by March 5th)

 

$20 Adult

$10 Child (ages 5-11)

$55 Family

   

At The Door

 

$25 Adult

$15 Child (ages 5-11)



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I would like to be a sponsor $180
(includes 2 reservations)

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 I will be mailing a check to Chabad Jewish Community Center, 3579 Arlington Ave., Suite 100, Riverside, CA 92506

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