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Rosh Hashana Dinner Registration

Full Name*
First Name Last Name
Phone*
E-mail*
Adults - $25*
Children - $15*
Amount

$
We will never turn away anyone due to insufficient funds

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

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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