Registration Form Community Shabbat Dinner November 7th, 2014 @ 6:00 PM at Chabad Jewish Discovery Centre 1552 Dundas Street West, Mississauga YES! I would like to join the festivities for Shabbat on Friday, November 7th at 6:00pm at Chabad JDC! Yes, I will be joining the Kabbalat Shabbat service prior to the dinner at 5:30pm My Full Name How many adults will be coming, including yourself? How many children will be coming with you? Phone number: E-mail address: I wish to pay by: Credit Card Check Cash Payment can be made either by entering your credit card information into the secure form below, paying at the door or sending a check to: Chabad of Mississauga 1552 Dundas St. W. Mississauga, ON L5C 1E4 $18 X Adult/s = $8 X Child (ages 2-12) = Gold Sponsor- $360.00 Silver Sponsor- $180.00 I would be happy to contribute another amount: Total: Card Type: Visa Mastercard Card Number: Expiration Date (mm/yy): Name on card (Last, First): Billing Address: City: Postal Code: Additional Comments (optional): This page uses 128 bit SSL encryption to keep your data secure.
