Lag B'Omer Registration
Thursday, May 23, 2019 • 6:30pm

First Name:
Last Name:
Address:    
                   City:           
            State:          Zip:
Phone:       
Email:        

Adults: $15 ($18 after May 20)
Children: $10 (ages 3-12) ($13 after May 20)

How many adults?   
How many children?

––––––––––––––––––– Sponsorship –––––––––––––––––––

Check this box to be a sponsor ($180) 

––––––––––––– Payment Information –––––––––––––
To pay by credit card, please complete the following:

Card type:

Name on card:
Card no:          
   Expiration:                              

Enter total amount:
________________________________
To pay by check, please complete:

I will mail a check:
Enter Total Amount:
to Chabad of the Inland Empire
8710 Baker Avenue, Rancho Cucamonga, CA 91730
(909) 949-4553