Welcome to our Purim on Rt 110 Reservation Form Please use this form only for Lunch time Megillah Reading. Click here to reserve for evening Purim Feast and game show A Purim Megillah reading for People on the go>Celebration for the Entire Family Megilla, Lunch, Hamantashen & more! THURSDAY, MARCH 21, 2019, 12:00 noon at Velocity Group USA, 290-300 Broad Hollow Rd, Ste 220E, Melville, NY 11747 For more information call Melville Chabad (631) 385-2424 PERSONAL INFORMATION Last Name City First Name State Address Zip Email Phone ADULT / CHILDREN RESERVATIONS SCROLL DOWN AND PRESS SUBMIT BUTTON WHEN DONE Name Name Adult Name 1 Child Name 1 Adult Name 2 Child Name 2 Adult Name 3 Child Name 3 Purchase Payments & Optional Contribution No Charge to attend but Sponsors appreciated Mordechai Sponsor: $180 - Queen Esther Sponsor: $360 Please charge my: VISA MasterCard American Express Discover Card Number: Exp. Date: mm/yyyy / CVV Code Card Zip code TOTALS Total Amount to be Charged: PRESS SUBMIT BUTTON WHEN DONE This page uses 128 bit SSL encryption to keep your data secure.
