I Am Registering For:

Adults:
Children: (12 and under)
   
First Name:
Last Name:
Phone:
Address:
City:
State:
Zip:
Email:
Notes:
Rates Per Person
Adult: $60
Child: $40 
Please consider an added donation to help others attend the Seder
Credit Card Info
Credit Card Type:
Card Number:
Exp. Date:
CVV:

Grand Total: (including Seder & Optional Donation to be charged)