Reservations Purim in Africa Monday, March 9, 2009 @ 7:00 PM Personal Information: Title: Please Select Mr. & Mrs. Mr. Mrs. Ms. Miss Dr. Prof. Hon. Mr. & Mrs. First Name: Last Name: Email: Additional guest in your party: We're old friends -You have my information!(skip next section) Address: City: State: Zip: Phone No: Fees: In Advance Reservervations (by March 5th) $20 Adult 0 1 2 3 4 5 6 7 8 9 10 $10 Child (ages 5-11) 0 1 2 3 4 5 6 7 8 9 10 $55 Family 0 1 2 3 4 5 At The Door $25 Adult 0 1 2 3 4 5 6 7 8 9 10 $15 Child (ages 5-11) 0 1 2 3 4 5 6 7 8 9 10 Optional I would like to be a sponsor $180 (includes 2 reservations) Other donation amount In honor memory of: All contributions are tax-deductible 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 This page uses 128 bit SSL encryption to keep your data secure.