Full Name*First NameLast NameE-mail*Date of EventMonthDayYear NON MEMBERS- Amount of space you'd likeSelect One1 Room (15-30 People) $4002 Rooms (30-60 People) $7003 Rooms (60-100 People) $1000MEMBERS 50% OFF- Amount of space you'd likeSelect One1 Room (15-30 People) $2002 Rooms (30-60 People) $3503 Rooms (60-100 People) $500Total$0.00Payment*Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearSubmit Clear Form100% of the proceeds of this donation or payment benefit Chabad of the West Side, EIN 11-2735027.Should be Empty: This page uses TLS encryption to keep your data secure.
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