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ב"ה

Holidays High Holidays

Rosh Hashanah Community Dinner

Full Name*

First Name Last Name
E-mail*
Phone Number

Area Code Phone Number
I would like to be a sponsor of the dinner - $180

Yes No
We are coming as a family - $136/Family

Yes No
Number of Adults attending - $36/Adult
Number of Children (2-12) attending - $25/Child
Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

CCV

Billing Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%
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