1. Personal information: Full Name* First Name Last Name E-mail* Address Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Phone Number Area Code Phone Number 2. Events I would like to attend... 1. Red Carpet Purim - Ckids Club Sun, Mar 5, 10:30-12:00pm 1 Child = $122 Children = $243 Children = $364 Children = $485 Children = $606 Children = $72 $12 per child Child/ren names & Ages: 2. Sushi, Scotch & Megillah Reading Mon, Mar 6, 7:00pm 1 Attendee = $252 Attendees = $503 Attendees = $754 Attendees = $1005 Attendees = $1256 Attendees = $150 $25 per person Name of attendees Purim in the 60's Sun, Mar 24, 4:30-6:30pm 1 Attendee2 Attendees3 Attendees4 Attendees5 Attendees6 Attendees7 Attendees8 Attendees9 Attendees10 Attendees Free | Donations Appreciated Kids Hamantash Bake Sun, Mar 1, 11:00-12:00am 1 Family2 Families3 Families $18 per Family Evening Megillah Reading Mon, Mar 2, 6:15pm 1 Attendee2 Attendees3 Attendees4 Attendees5 Attendees6 Attendees7 Attendees8 Attendees9 Attendees10 Attendees Free | Donations Appreciated Purim in Hawaii Tue, Mar 3, 5:00pm Yes Adult $20 per adult 1 adult2 adults3 adults Children $10 per child 1 child2 child3 child Names of attendees YES! I want to help sponsor these Purim events for our community! Sponsorship amount We appreciate your partnership!! Purim Sponsor - $2500Megilla Sponsor - $1800Esther Sponsor - $1000Mordechai Sponsor - $500Feast Sponsor - $360Hamantash Sponsor - $180Graggers Sponsor - $72 3. Payment Payment options Credit Card Check/Cash Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearPlease mail check to:Chabad of Chula Vista2086 Otay Lakes Rd #101Chula Vista, CA 91913 Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% No one will be turned away to due to lack of funds. If you need assistance, please contact us. Questions/Comments Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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