Programming Registration Form

First Name

 

E-Mail

Last Name

 

Phone

 

       
Program You Are Registering For
Men's Camping Retreat $60.   Purim 2018 Cocktails and Costumes - $15 per person
Pesach
Adults $45 | Children under 12 $18
  Shakes in the Shack - $5 per child
Friday Night Dinner
$8 per person
     
         
Payment
CC Type   Card Number
Numbers only, no spaces or dashes
Billing Address   City, State, Zip
Charge Amount
Numbers only, no additional character
$   Exp Date
CVV