JLI reservation form below: 6 Wednesday's starting Nov. 5th, 2014

[1]  PERSONAL INFO

   [2]  RESERVATIONS

Last Name

  

Please select the number of people attending. 

 Adults
 

First Name
Address
City
State
Zip
Phone
E-mail

 

[3] PAYMENT
      $79 per Adult, $138 per Couple (one book pr couple), $360 per Sponsor 

 Please charge my card below
  I will send a check in the mail  
Total Amount    Comments (optional)
Card Type  
Card Number  
Expiration    
Cvv Code  
Please make checks payable to Chabad of Delray Beach, Mail to :7495 W. Atlantic Ave, Delray Beach FL 33446
Acknowledgement
Email Address*
Reconfirm Email Address*
You may acknowledge my gift to my email address
Please acknowledge my gift by mail to the above street address

Reservation is not complete without payment