Temple B'nai Israel Clearwater

Please use the form below to sign up for our 2021 Virtual Trivia Night.

Questions about this form? Please contact the temple office at (727) 531-5829.

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Qty

Description

Amount

Total

Trivia Night Entry Fee

$5.00

---

Per Person

Sonny's Dinner Option 1 Sold Out

$12.00

---

1/4 BBQ Chicken Platter w/ 2 Sides

Sonny's Dinner Option 2 Sold Out

$12.00

---

BBQ Pulled Chicken Platter w/ 2 Sides

50/50 Raffle - Single Ticket

$5.00

---

50/50 Raffle - 6 Ticket Deal

$25.00

---

Total: $0.00

For each Trivia Night Entry Fee purchased above, please enter a Participant Name.

Participant #1 Name:

If you purchased a dinner option above, please choose a Sonny's pickup location:

Sonny's pickup location:

Note: We will contact you regarding choosing your dinner side items.

Payer Information

First Name: *

Last Name: *

Company Name:

Billing Address: *

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

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *