Event Reservation Form

Contact Information

Title

First Name

Last Name

Address

City

State

Zip

Phone

Attendee Information

Please know: the suggested amount is to help us cover part of the large expense entailed in a community seder. However, lack of funds should not be a reason to miss out on this important Mitzvah. Our goal is to have everyone participate with us for any amount or free of charge. Please call us at 847-350-9770

Guest Type	Number of Guests	Amount	Discount	Total
Adult		65.00
Child (2-12)		37.00
Total

Please consider adding a donation for Maot Chitim to help needy families in our community for Passover.

Donation Amount

Total Amount

Promo Code

Payment Information

Name on Card

Card Number

Card Expiration

Security Code

Same as above

Billing Address

Zip Code

Note