Full Name* First Name Last Name Phone Number* Area Code Phone Number E-mail* What city are you coming from?* Number of Adult Men Number of Adult Women Number of Children List the names of people in your party Services You Want to Attend Rosh Hashanah EveRosh Hashanah Day 1Rosh Hashanah Day 2RH Family ServiceShofar at The LakeKol NidreiYom KippurYK Family Service I would like to make a dedication in the Yizkor Book during Yom Kippur* YesNo # of Names* $18 per name List Names to Be Added to the Book* Please consider making an optional donation. Minimum suggested donation is $100 per adult and $50 per child. Kiddush sponsorship or partial sponsorship is $360, $180 or other. Break the Fast sponsorship or partial is $500, $360, $180 or other. Other sponsorship opportunities are also listed below Thank you. Donation and Sponsorships $2500, High Holiday Cantor/Chazan Sponsor$1800, Shana Tova Superstar Sponsorship$1200, Rosh Hashana Security Sponsor$800, Yom Kippur Security Sponsor$750, Family and Children's Program Sponsor$500, Rosh Hashana Day 1 and Day 2 Kiddush Sponsor$500, High Holiday Publications Sponsor$500, Break the Fast Sponsor$360, Partial Break the Fast Sponsor Please reserve my seat, I do not want to make a donation at this time. (Note: When selecting "Please reserve my seat, I do not want to make a donation at this time." The submission response text may indicate a price paid/ to be paid, but we can assure you that you will NOT be charged for the amount specified. Upon submitting the form, please select "Other" as payment method. Thank you!) If you would like to reserve your seat/s but would like to make a smaller donation than the suggested donation amount: Kindly check the "Please reserve my seat, I do not want to make a donation at this time" box and submit your registration. You may send your intended donation amount through the Secure Donate Form by clicking this link and indicating that the donation is for the High Holidays in the Dedication Details. Thank you! Total $0.00 Payment Credit Card Paypal Other Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearPaypal has been selected. Payment will take place on the next page.Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit Clear Form Click here to download a printable version Should be Empty: This page uses TLS encryption to keep your data secure.
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