SHAVUOT 10 COMMANDMENTS & ICE-CREAM PARTY TO-GO RESERVATION FORM Name Address: Street City State Zipcode Phone Email # of Adults @ Please Select 0 1 2 3 4 5 # of Children @ Please Select 0 1 2 3 4 5 EVENT IS FREE, donations appreciated: Sponsor @ $100 OR I would like to make a donation in the amount of to help pay for someone that cannot afford. Total Amount I would like to pay via: Check Credit Card Total Amount: Add 3% for credit card processing 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 2019 2020 2021 2022 2023 2024 CVV Street: City: Zipcode: Please add 3% to my total to help cover credit card processing charges. Please mail check to: Chabad Jewish Center of Northern Colorado 1121 W. Prospect Rd, Suite 140, Fort Collins, CO 80525 This page uses 128 bit SSL encryption to keep your data secure.