Purim in the Wild West Wednesday, February 28 | 5:45 pm Chabad of Putnam 5 Fair Street Carmel NY 10512Full Name*First NameLast NameE-mail*Phone Number*Area CodePhone NumberPre-Registration & Payment by February 25th: $15 Adult | $10 Child (3-12) After February 25th and door Price: $18 Adult | $12 ChildAdults $15 - After Feb 25th $18Children $10 - After Feb 25th $12$180 Queen Esther Sponsor $360 Mordechai Sponsor I want to sponsor$100 USD$180 USD$360 USDTotal Charge$0.00 USDPayment MethodCredit Card Paypal Cash or Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2018201920202021202220232024202520262027Expiration YearPaypal has been selected. Payment will take place on the next page.Please note payment must be received by February 25th to get early bird priceComments? Questions?Add to mailing listSubmitShould be Empty: This page uses TLS encryption to keep your data secure.
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