Congregation Emanu-El of the City of New York

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Teen Leadership Shabbat Kodesh & Family Dinner

Friday, April 3 | 6:00 PM (service) Fifth Avenue Sanctuary, 7:00 PM (dinner) Wise Hall | One East 65th Street

This month’s service will honor high school students who have taken on a leadership role within our congregational community. A Family Dinner open to all temple members will follow the service.

Payments for dinner must be received before the event. The basic charge for dinner is $55 per family (up to two adults and any number of children) for reservations made by March 30, 2020; $75 after March 30. Teens (8th-12th graders), if unaccompanied by an adult: $15 each. Additional adults: $20 each. After March 30, cancellations cannot be refunded.

DINNER RESERVATION

Qty

Description

Amount

Total

Family Reservation

$75.00

---

(up to two adults and any number of children)

Teens (8th-12th graders)

$15.00

---

(unaccompanied by an adult)

Additional Adult(s)

$20.00

---

Total: $0.00

Family Information

Are you Temple members? *

Family Last Name: *

First Name (Adult 1):

First Name (Adult 2):

Please include the last name if it differs from Adult 1.

Please indicate the name of each child attending and his or her current school grade.

Name/Grade of Child #1:

Include the first and last name of each additional adult who will be attending dinner.

Additional Adult #1:

Questions/Comments:

Please let us know if you have any questions or concerns.

Contact Information

Person Completing Form: *

Preferred Email Address: *

Preferred Phone Number: *

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

Email: *

A receipt will be emailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *