Purim in THE PALACE Dinner Payment Form
Thursday, March 1,  2018 |
 5:00pm


*
Denotes required field

Amount of People:*

ADULTS

CHILDREN
Ages: 5 to 13

FAMILY 

PURIM SPONSOR $180
Become a sponsor for the Community Oneg
TOTAL AMOUNT $
Title*
First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State
Post Code*
Country*
This is my home business address.
Card Type*
Card Number*
Expiration Date*
CVV #*
 
Reservation Confirmation
Email Address*
Reconfirm Email Address*
Please email Confirmation
Please send confirmation by mail to the above street address.