FIFTH GRADE / HEY MILESTONE MOMENT AND SHABBAT DINNER

Program Details

Fri / Apr 12 / 5:45–6:15 pm / 87th Street, Third Floor Chapel

Fri / Apr 12 / 6:15–7:15 pm /87th Street, Main Sanctuary Services

Fri / Apr 12 / 7:15 pm / 87th Street, Ballroom 3, Dinner

Cost per Adult and Child:

$20 per Adult

$15 per Child

Information

Adult's First Name

Adult's Last Name

Adult's Email

Adult's Phone

Total Number of Adults Attending

Total Number of Children Attending

Adult 2 First Name

Adult 2 Last Name

Adult 3 First Name

Adult 3 Last Name

Adult 4 First Name

Adult 4 Last Name

Adult 5 First Name

Adult 5 Last Name

Child 1 First Name

Child 1 Last Name

Child 2 First Name

Child 2 Last Name

Child 3 First Name

Child 3 Last Name

Child 4 First Name

Child 4 Last Name

Child 5 First Name

Child 5 Last Name

Please Note any Allergies in your Family that is Attending

Disclaimer: Photos of you may be taken during this event. Park Avenue Synagogue may use these photos in synagogue publications, flyers and on the screens in the lobby.

I have read and agree to the above statement.

Registration Total

Amount Due

Credit Card Information

First Name on Card

Last Name on Card

Credit Card Number

Exp Month

Exp Year

Security Code

Billing Address

Billing City

Billing State

Billing Zip Code

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