Community Passover Seder | www.jewishcanton.com

Your Info

First Name *

Last Name *

Email Address *

Street Address

Phone

Number of Adult Attendees

Number of Children Attendees

this event costs $40/ adult $20/ child

Number of adult attendees

$40.00

number of children attendees

$20.00

Total

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *