Click here to download a printable version 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 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 $3500, High Holiday Cantor/Chazan Sponsor$1800, Shana Tova Superstar Sponsorship$1000, High Holiday Security Sponsor$750, Family and Children's Program Sponsor$500, High Holiday Publications Sponsor$500, Break the Fast Sponsor$360, Partial Break the Fast Sponsor$500, Rosh Hashana Day 1 and Day 2 Kiddush 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. 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 Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year Paypal has been selected. Payment will take place on the next page. Billing Address Street Address City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.