Passover Seder Reservation Form
Your Name(*)
Please let us know your name.
Please enter your name
Your Email address(*)
Please let us know your email address.
Please enter a valid email address
Your phone number(*)
Enter phone number (123-456-7890)
Please enter a valid phone number
# Adults (age 13+)(*)
Invalid Input
Number of adults 13 and older. $50 for members; $55 for non-members.
# Children (age 4-12) or Aids
Invalid Input
Number of children age 4 - 12, or aids for the elderly ($25).
# Roast Chicken Dinners
Invalid Input
Number of roast chicken dinners (adults and aids only)
# Beef Dinners
Invalid Input
Number of beef dinners (adults and aids only)
# Vegetarian Dinners
Invalid Input
Number of vegetarian dinners (adults and aids only)
# Kiddie Dinners
Invalid Input
Number of children's dinners (age 4 - 12 only)
# Diabetic Dessert
Invalid Input
Number of diabetic desserts.
Comments
Please let us know your message.
Total $(*)
Invalid Input
Please calculate the total and enter here. Members meals: $50; Non-member meals: $55 Children (4-12) and aids: $25
Payment method(*)
Invalid Input
How will you pay?
Click Submit button to save registration