Purim  2020

at Chabad on Carlisle - Jewish Russian Centre

Tuesday 10 March 6:00 pm

Simply complete the form below and click the button to submit your Purim payment.

*denotes a required field

Person 1
Title

First Name*

Last Name*
Gender Male Female
Email Address*
   

Payments:

$40.00 per adult: 

$20.00 per child: 

$180.00 Sponsor (Includes 1 ticket): Please tick

Please provide us with the names of all  additional persons included in your Purim payment: 

Person 2

Title 

First Name :  Last Name : 

Male Female

Person 3

Title 

First Name :  Last Name : 

Male Female

Person 4

Title 

First Name :  Last Name : 

Male Female

Payment by Credit Card

Total: $ 

Card Type* 

Card Number* 

Expiration Date*  CCV Security Code*  

Please click submit only once. 
Please wait for the acknowledgement message that your information was received