Seat Reservations members

Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number

E-mail*

Current Membership Plan

$1000 Seasonal Associate Friend of Chabad$1000 Single Membership (Includes 1 High Holiday seat for adult)$2000 Family Membership (Includes 2 High Holiday seats for adults)Honorary - $3600 (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$5,000 Gold Membership (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and 2 VIP seats at lectures)$10,000 Pillar of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and JLI course for a couple)$18,000 Founder of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and a private trip with Rabbi Bukiet to the Rebbe's Ohel)

Complementary Seats included in your Membership
(please only choose the amount included in your membership)

Please indicate when seats are needed:**

Rosh HashanaYom Kippur

How many men's seats*

How many women's seats*

Would you like to purchase additional seats:* Additional seats are $75 per seat

YesNo

How many men's seats*

How many women's seats*

Names of attendees*

Any comments / seating preferences

Would you like to enroll your children or infants in the Children's Program:*

YesNo

How many children will be joining:* Ages 4 - 12

Which days will your child(ren) be attending:*

Sept 12th: Rosh Hashana day 1Sept 13th: Rosh Hashana day 2Sept 20th: Yom Kippur EveSept 21st: Yom Kippur Day

Child #1: Name*

Child #1: Age*

Child #2: Name*

Child #2: Age*

Child #3: Name*

Child #3: Age*

Child #4: Name*

Child #4: Age*

How many children will be joining:* Ages 18 months - 3 years

Child #1: Name*

Child #1: Age*

Which days will Child #1 be attending:*

Sept 12th: Rosh Hashana day 1Sept 13th: Rosh Hashana day 2Sept 20th: Yom Kippur EveSept 21st: Yom Kippur Day

Child #2: Name*

Child #2: Age*

Which days will Child #2 be attending:*

Sept 12th: Rosh Hashana day 1Sept 13th: Rosh Hashana day 2Sept 20th: Yom Kippur EveSept 21st: Yom Kippur Day

Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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Holiday Date

Seat Reservations for members

Your Information

High Holiday Seat Reservation

Children's Program

Babysitting Group

Payment Info