This form is currently closed. Craft and customize a mirror featuring the traditional blessing for the home. Enjoy an evening of connection, creativity, and light refreshments. Attendee Information Full Name* First Name Last Name E-mail* Cell Number* Area Code Phone Number Donation Options Suggested Donation $25I want to sponsor a friend $25I want to be a co-sponsor $100I'd like to come with no donation Any Other Attendees? Questions? Comments? Total $25.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% Payment Credit Card Paypal eCheck Cash/Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearPaypal has been selected. Payment will take place on the next page. Bank Name Routing Number Account NumberCheckingSavingsBusiness Account TypeI will pay in person or mail a check For more info: Contact Mrs. Fraida Schusterman 347-683-2530 or email [email protected] Should be Empty: This page uses TLS encryption to keep your data secure.
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This page uses TLS encryption to keep your data secure.
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