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Purim Fiesta  Registration Form

First Name

 

E-Mail

Last Name

 

Phone

Number of Children   Number of Adults

 

       
Pricing
  Adult $22 | Child (2-12) $12  

Co-Sponsor

$180 (includes family reservation)      
Gold Sponsor $360 (includes family reservation)      
   
Payment
CC Type   Card Number
Billing Address   City, State, Zip
Charge Amount   Exp Date
CVV

I will send a check (mail to 1 west 9th St. Frederick, MD 21701)