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Rosh Hashanah Community Dinner

Rosh Hashanah Community Dinner Reservation Form

NOTICE: 5 seats became available. This form will close after they are filled.

Sponsors:
Mr. Jack & Dr. Suzy Berkowitz
Dr. Ira & Karen Kanis
Dr. Robert & Mary Ann Stein
Dr. Jordan Goetz
Lori & Willie Hirsh
Eli Ram
Ofir & Rachel Avgush
Dr. Ken & Kriten Steier
Louis & Grace Korman
Fred Malkin
Dr. Michael & Corbett Hoffman
Full Name
First Name Last Name
E-mail*
Phone Number

Area Code Phone Number
Number of adults ($36 each)*
Number of children ($18 each) Ages 2-12. Under 2 is free, over 12 is adult
Note
Optional Donation / Be a Sponsor!

$54$72$180$360$540$613$1000$1800$3600
Donation Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment Method

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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