| JWC Registration Form Sept. 23rd 2013 |
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First Name
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E-Mail
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Last Name
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Phone
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| Number of Women |
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Pricing $15 Adults *No one will be turned away due to lack of funds*
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Total:
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Payment -
Reservations are only complete once payment is received .
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| by credit card below by mailing cheqe to Chabad Jewish Centre - 1121 Dundas St. East, Whitby ON L1N 2K4 |
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Card Number |
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| Billing Address |
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City, State, Postal |
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| Charge Amount |
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Exp Date |
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