Congregation Yemei Teshuva

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Please Note: Services at Congregation Yemei Teshuva are exclusively for Boca West members, their families and guests. If you are not a member of Boca West, and have not attended services in the past, you must have a member host you. Please indicate the name of your host in the comment section below.

Qty

Description

Amount

Total

Boca West Member Ticket(s)

$150.00

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Parent Ticket(s)

$150.00

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Offspring Ticket(s) ~ 13 years of age or older

$150.00

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Offspring Ticket(s) ~ under the age of 13

$0.00

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Guest(s)

$150.00

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Names in Memorial Yizkor Book

$18.00

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per name - see below

Total: $0.00

Yizkor Memorial Book

(If you are ordering Yizkor names, please ensure you Pay for and enter the number of Yizkor names in the section above in the box labeled Names in Memorial Yizkor Book.)

Names are the Same as Last Year or Enter names below
(If you check this box, please ensure you still Pay for and enter the number of Yizkor names in the section above in the box labeled Names in Memorial Yizkor Book)

Yizkor Name 1:

Yizkor Name 2:

Yizkor Name 3:

Yizkor Name 4:

Yizkor Name 5:

Yizkor Name 6:

Yizkor Name 7:

Yizkor Name 8:

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: *

Cell Phone:

E-mail: *

A receipt will be e-mailed to this address.

Comments:

(if you are a guest, please list the name of your host here)

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *