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Men's Club Shabbat Dinner Order Form

Please submit your order for dinner at the Tu B'Shvat Seder on February 3rd!

$12 per adult/$7 per child
Rotisserie Chicken
Potatoes
Vegetable
Challah
Dessert

Please place your order by no later than 5:00PM on Wednesday, February 1st.

# of Adult Meals

# of Kids Meals

* Name

* Phone Number

* Email

Additional Comments

Use this space if you filled out the Family Max field to indicate your meal choices.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Please increase the payment amount by 3% to cover the cost of credit card fees (No fee for Checking)

Total: