Scholar in Residence Shabbaton

Please fill out information below for the Shabbaton. Please note that all children under 4 are free. Please do fill out quantities for attending children, so that appropriate food quantities can be prepared.
Name
First Last
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Lunch Pricing
18 years or older: $20
Price: $20.00 Quantity:
Children ages 12-17: $15 per child
Price: $15.00 Quantity:
Children ages 5-11: $10 per child
Price: $10.00 Quantity:
Children Under 4 - free
Price: $0.00 Quantity:
Family Maximum - $60
- Yes, I would like to pay the discounted price of $60 for my entire family for lunch
Entire Family
Price: $60.00 Quantity:
Number of family members attending
Please indicate total family members
Melave Malkah Pricing
Adult - Melava Malkah
Price: $18.00 Quantity:
Couple - Melava Malkah
Price: $30.00 Quantity:
Would you like to cover the service fee so that 100% of my donation will benefit B'nai Israel Ohev Zedek
- Yes, I would like to cover the merchant service fee
Merchant Service Fee
Price: $0.00
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name