Chanukah Kumzitz Banner.jpg

I would like to make reservation(s) for the Chanukah Dinner & Kumzitz on Tuesday, December 4th.

Attending (@ $20 ea.)

 Family Attendance ($80)

Sponsor (@ $180) Please indicate above how many family members will be attending

Title*

First Name

Last Name

Address Line 1

Address Line 2 

City

State  Zip Code

Phone

This is my home business address

Please charge my Credit Card in the amount of $

Please add 3.5% to cover credit card processing fees.

Card Type*

Card Number

Expiration Date*

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Email Address*

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