Repair the World Ticketed Program Signup

Please use this form to signup for the below program. The suggested ticket prices are described in "About the Program" below, and you can select your option by editing the value in the "Amount" field.

If cost is a barrier to entry, please contact the person referenced below in About the Program.

We look forward to welcoming you to Repair the World's programming.

Program Information

Program Title

Program Date

Venue Name

Venue Address

About the Program

Interested in learning more about economic justice and the Fair Tax campaign? Join Silverstein Base Hillel, Mishkan, JCUA, Avodah, and Repair the World for our 4th annual Justice Series cohort. The cohort will meet every other week from 7-9pm on Wednesdays from February 5-April 3 (Feb 5, 19, March 4, March 18, April 3), concluding with a Shabbat dinner on Friday night.

Your Information

Your First Name

Your Last Name

Personal Email

You'll receive emails from Repair the World. You may unsubscribe at any time.

Cell Phone Number

Street Address

City

State

Zipcode (5 digits)

Your Ticket Information

Amount: $

Please format your amount with cents, i.e. XX.XX

Would you like to cover the credit card processing fee of 2.5%?

YesNo

Total Amount: $

Payment Information

I am the cardholder

Cardholder First Name

Cardholder Last Name

Billing Email

Cardholder First Name

Cardholder Last Name

Billing Email

Credit Card Type

Card Number

Code

IDs

Community ID

GAU ID

Opportunity ID

Contact ID

Account ID

Contact Information