RESERVATION FORM BELOW... Scroll Down Purim Registration Form March 5th 2015 First Name E-Mail Last Name Phone Number of Adults Number of Children We will be joining the Megillah reading at Chabad on the 4th @ 7:00pm Please select Yes No Pricing After February 20th, $19 per Adult, $16 Child (12 & under)* (Children under 2 are free) ADVANCED RATE: Reserved and paid by Feb. 20th, $15 per Adult , $12 a Child (12 & under) *no one will be turned away due to lack of funds I would like to be a Purim Sponsor $180 No Yes Total: Payment - Reservations are only complete once payment is received. by credit card below by mailing cheqe to Chabad Jewish Centre - 1121 Dundas St. East, Whitby ON L1N 2K4 CC Type Please select Visa MasterCard Discover AMEX Card Number Billing Address City, State, Postal Charge Amount Exp Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2015 2016 2017 2018 2019 2020 CVV Comments: This page uses 128 bit SSL encryption to keep your data secure.
