High Holiday Reservation Form 5785

ROSH HASHANA - OCTOBER 2 - OCTOBER 4

YOM KIPPUR - OCTOBER 11 - OCTOBER 12
Full Name

First Name Last Name

Address

Phone Number

Area Code Phone Number
E-mail
PLEASE SELECT WHICH HOLIDAY AND SERVICE YOU WILL BE ATTENDING - REQUIRED. PLEASE NOTE THAT WE WILL HAVE CHILDREN'S PROGRAMMING DURING SERVICES.
Please select which Holiday you will be attending: (Required)*
Please select which Service you will be attending: (Required)*
Please indicate the number of seats you require in the men's and/or women's section - REQUIRED
# of Men*
# of Women*
Please include name of guest if different than full name:
HIGH HOLIDAY COSTS FOR SEATS - ANYONE JOINING WILL BE ASSESSED A SECURITY FEE.
$1,980 FAMILY (4 PEOPLE) + $360 SECURITY FEE - $2,340

$1,800 COUPLE (2 PEOPLE) + $360 SECURITY FEE - $2,160

$990 SINGLE (1 PERSON) + $180 SECURITY FEE - $1,170

$440 EACH ADDITIONAL FAMILY MEMBER/GUEST (NOT A SPOUSE)

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Family - 4 people + $360 Security Fee

$2340
Couple - 2 People + $360 Security Fee

$2160
Single - 1 Person + $180 Security Fee

$1170
Additional Guests - $440 Each Additional Member/Guest (Not a Spouse)

$440$880$1320$1760
Total

$0.00
Comments
Wishing you and your family a happy, healthy and sweet new year!
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PLEASE SELECT WHICH HOLIDAY AND SERVICE YOU WILL BE ATTENDING - REQUIRED. PLEASE NOTE THAT WE WILL HAVE CHILDREN'S PROGRAMMING DURING SERVICES.