Old High Holiday Registration Form (unformed)

Welcome to our High Holiday Reservation Form.
We're offering you a hassle-free way to make seat reservations and purchase lulav & etrog sets - all with one simple click!

Suggested Donation: $150 Per Adult. Please note that no person will be turned away due to inability to pay.

All High Holiday Services will take place at the Villa Amalfi Social Hall -
793 Palisade Ave. in Cliffside Park. Across from the Winston Towers 

Contact Info			Holiday Reservations / Purchase Selections
Last Name			I will be using this form to: (check all that apply)
First Name				Reserve Seats
Address				Purchase Lulav/etrog set
City/State/Zip
Phone
Email
SEAT RESERVATIONS $150 PER ADULT  (CHILDREN FREE)
Adults	How Many Adults? 1 2 3 4 5 6 7 8		Children	How Many Children? 1 2 3 4 5 6 7 8
Adult Name 1			Child Name 1
Adult Name 2			Child Name 2
Adult Name 3			Child Name 3
Adult Name 4			Child Name 4
Adult Name 5			Child Name 5
Adult Name 6			Child Name 6
High Holiday Services I plan to attend
	Rosh Hashana Eve
	Rosh Hashana First Day
	Rosh Hashana Eve
	Rosh Hashana Second Day
	Yom Kippur - Kol Nidrei
	Yom Kippur Day
	Yom Kippur - Neilah
Comment:
Lulav & Etrog
Yes, I'd like to order 0 1 2 3 4 lulav/etrog set(s).   Please charge me $45/set
PURCHASE PAYMENTS & OPTIONAL DONATION Help Chabad continue to help others with your optional generous contribution!
CC Type	Select One Visa Mastercard American Express Discover		Card #:
Purchase Total			Exp. Date	Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Select 2010 2011 2012 2013 2014 2015 2016
Donation Amt.			Charge Details