Purim in the Stadium Registration - Chabad Lubavitch of Western Monmouth County
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Purim In The Stadium Party Registration

Purim in the stadium.png

Personal Info:  
Name:

Phone:

Email:  
Address:  
City/

Zip Code:
Total Attending:

Adults:
Children:

Cost:
Adult: $25.00 | Child: 15.00
Family of four $75 | Sponsor $180

Purim Payment Info:  
I will send/drop off a check Please charge my card $
Card Number:
Exp:
CVV:
Name on Card:

Comments:

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