Congregation Emanu-El of the City of New York

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Shabbat Shira Family Dinner

Friday, January 26, 2018 • 7:15 PM • One East 65th Street

Immediately following the 6 PM Shabbat Shira (Sabbath of Song) service in the Fifth Avenue Sanctuary, Religious School families and teens are invited to a Sabbath dinner where we will be honoring our Religious School faculty. Activities for children will be offered.

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 January 22, 2018; $75 after January 22. Teens (8th-12th graders), if unaccompanied by an adult: $15 each. Additional adults: $20 each. After January 22, 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: *