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Your Registration Info
First Name
*
Last Name
*
Email Address
*
How many adults?
*
- select How many adults? -
1
2
3
4
5
How many children?
- select How many children? -
1
2
3
4
5
Optional Donation
Optional Donation
Bronze Sponsor
-
$ 36.00
Silver Sponsor
-
$ 72.00
Gold Sponsor
-
$ 180.00
Event co-Sponsor
-
$ 360.00
Event Sponsor
-
$ 720.00
Other amount
Total
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Chabad of My Town
info@chabadmytown.com
|
(999) 123-4567
|
120 Main St, My Town
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