SHAVUOT 10 COMMANDMENTS & ICE-CREAM PARTY TO-GO 

RESERVATION FORM

Name

Address:

Street  

City    State   Zipcode 

Phone     Email

 

# of Adults @      # of Children @      

 

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:   Card Number  

Exp.         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