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Your Registration Info
Individual Prefix
*
Mr.
Mrs.
Ms.
Rabbi
Dr.
Mr. and Mrs.
Mrs. and Mr.
Rabbi and Mrs.
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Number of Participants (including yourself)
*
- select Number of Participants (including yourself) -
1
2
3
4
5
6
7
8
9
Event Fee(s)
How Many Adults
$36.00
(includes Sales Tax of $0.00)
How Many Children under 12
$18.00
(includes Sales Tax of $0.00)
How Many Children under 2
$0.00
(includes Sales Tax of $0.00)
College Student
$0.00
(includes Sales Tax of $0.00)
Post Doc Family
Optional Donation
Total
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Use a new card for this payment. This card will not be saved unless it is for recurring charges.
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Jewish Israeli Center New Haven
rabbi@jewishicnh.org
|
203.809.6023
|
408-410 Whalley Ave New Haven CT 06511
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