Purim in China Reservations
Donations & Sponsorships

Personal Information
Title:
Last Name:
First Name:
Address:
City:
State:
Zip:
Phone:
E-mail:

$18 Adult
$10 Students & Children (Ages 5-11)
$50 Family

Adults: Child: Student:

 I would like to sponsor this event for $180.00
I would like to donate
In honor memory of:

Total:


Payment Information
Card Type:
Name on Card:
Card No:

CVV Security Code:

  What's This?
Expiration Date:

Payment by Check:
 I will be mailing a check to Chabad Jewish Community Center. Please print out this page and send the completed form along with your payment to:
Chabad Jewish Community Center
1370 Le Conte Drive,
Riverside, CA 92507

 I would like to be added to the mailing list.

Comments: