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Arabian Nights Purim in Persia Party

Grand Purim Celebration Registration Form

Feeling the pinch? We never want finances to get in the way of participating. If the price is an issue, simply register using this link instead, let us know how many people will be attending, and choose an amount you can afford to pay.

Feeling generous? Be a Purim sponsor! Even if you can't make the event, you can help make it for others. To be a sponsor, please see below.

Purim Sponsors (to date):
Henry & Samira Galler
Gil & Phyllis Goetz
Steve & Hanna Hirsch
Pinny & Sonia Young
Jack & Suzy Berkowitz
Lee & Michelle Sentell
Siggy Toback
Rachid & Liat Mosker
Les & Theresa Rosen
Michael & Corbett Hoffman
Manny & Rachel Reiser
Steve & Hanna Hirsch
Sponsors of $100 or more will be listed here
Full Name

First Name Last Name
E-mail*
Phone Number

Area Code Phone Number
How many adults (ages 12+)? $25 per adult
How many children (ages 2-12)? $18 per child. 2 and under are free
Notes
Donation / Sponsors Donations $100+ will be listed as event sponsors

$36$54$100$180$360$540$800$1000$1800
Total

$0.00

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

Payment

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

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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