Community Purim Party Thursday, March 1, 5pm Senior Center - 1200 Raintree Drive, Fort Collins Name Address Phone Email # of Adults @ $15 Please Select 0 1 2 3 4 5 # of Children @ $10 Please Select 0 1 2 3 4 5 Sponsor @ $100 No-one turned away for lack of funds Total Amount: I would like to pay via: Check Credit Card Card type: Please select Visa Mastercard American Express Card Number Exp. Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2013 2014 2015 2015 2016 2017 2018 2019 2020 CVV Please add 3% to my total to help cover credit card processing charges. This page uses 128 bit SSL encryption to keep your data secure. This page uses 128 bit SSL encryption to keep your data secure.
