Shabbat Adult's Night Out - Form - Merrick Jewish Centre

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Shabbat Adult's Night Out

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First Name of Attendee #1

Last Name of Attendee #1

Email Address

Phone Number

First Name of Attendee #2

Last Name of Attendee #2

Email Address

Phone Number

Number of Members attending @ $30 person

Number of Non-Members attending @ $40 per person

Total Amount Due

Wed, September 28 2022 3 Tishrei 5783

225 Fox Boulevard • Merrick, NY 11566 • 516-379-8650

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