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Your Registration Info
First Name
*
Last Name
*
Email Address
*
Mobile
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Event Fee(s)
# of child attending
*
- select # of child attending -
1 Child - $ 0.00
2 Children - $ 0.00
3 Children - $ 0.00
4 Children - $ 0.00
5 Children - $ 0.00
6 Children - $ 0.00
7 Children - $ 0.00
8 Children - $ 0.00
9 Children - $ 0.00
10 Children - $ 0.00
# of adult attending
*
- select # of adult attending -
1 Adult - $ 0.00
2 Adults - $ 0.00
3 Adults - $ 0.00
4 Adults - $ 0.00
5 Adults - $ 0.00
6 Adults - $ 0.00
7 Adults - $ 0.00
8 Adults - $ 0.00
9 Adults - $ 0.00
10 Adults - $ 0.00
Optional Tax Deductible Donation
$50
$100
$180
$360
$1000
- none -
Total
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Use a new card for this payment. This card will not be saved unless it is for recurring charges.
Event participant names
Please type the names of each person attending (for security reasons)
*
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JEMS
admin@jems.org.au
|
Rabbi Yossi - 0450 524 770
|
36 Flood Street, Bondi NSW 2026 AUSTRALIA
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