Event Reservation Form

Contact Information (Page 1 of 3)

Contact Information

Title

First Name

Last Name

Address

Zip Code

Phone

Attendee Information (Page 2 of 3)

Donations can be made on the next page

Please select the services you plan to attend. You are always welcome to join us for all, regardless of reservation:

Guest Type	Quantity	Charge	Total Charge
Kol Nidrei 6:30-8:30 pm - Men		0.00
Kol Nidrei 6:30-8:30 pm - Women		0.00
Morning Services 10:00am-2:15 pm - Men		0.00
Morning Services 10:00am-2:15 pm - Women		0.00
Child Supervision - from 11:00 am		0.00
Mincha/Breakfast 5:22-7:22 pm - Men		0.00
Mincha/Breakfast 5:22-7:22 pm - Women		0.00
Child Supervision - Mincha/Breakfast		0.00
Total Guest

Please include names (and ages of children)

Payment Information (Page 3 of 3)

Chabad of Arcadia is funded entirely by the local community. Generous people like you make all of this possible.

Your gift will provide a welcoming High Holiday experience for so many people.

Please partner with us in bringing the fellowship and inspiration of the High Holidays to the entire community.

Suggested donation: $180/per person. There is no cost to pray with Chabad. No one will be turned away due to lack of funds.

Reservation Amount

Donation Amount

Total Amount

Card Type

Card Number

Card Expiration

Security Code

Same as above

Name on Card

Billing Address

Zip Code