Purim at the Shore Reservations

Thursday, March 5, 2015 · 5:30 pm 
Regency House-Best Western Hotel 
140 Route 23 • Pompton Plains, NJ


First Name:   

Last Name:   





Phone #:


Number of people attending:

#  of Adults and children 14 and older    $28 per Person

 # of Children:  3-13 years $10


Children under 3 free 

I want to make a contribution to help sponsor the Purim Fest! ( your Name will be announced at the event) of:

$ US

Payment information

 I will pay with a credit card     check/cash

Billing Information
Credit Card Type
Card Number
Expiration Date

Security Code

 Signature of name on card

Total  $  

*Please mail check to the

Chabad Center 194 Ratzer Road Wayne NJ 07470

in time for it to arrive at least 3 days before the event.