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Shabbat 360 Registration Form

Shabbat 360 Registration Form

 

 SHABBAT 360 REGISTRATION FORM

EVENT: 4 April 2014

Once you have completed this form your name will automatically be entered into a raffle to win a ticket to Israel! 

FIRST NAME:    

FAMILY NAME: 

SCHOOL:            

YEAR:               

SHULE:             

TEL:                 

EMAIL:              

HOW DID YOU HEAR ABOUT SHABBAT 360?

WOULD YOU LIKE TO BE INFORMED ABOUT FUTURE  SPARKS EVENTS? 

PAYMENT BY CREDIT CARD

PAYMENT BY DEBIT CARD    

CARD TYPE VISA OR MASTERCARD: 

CREDIT/ DEBIT CARD NUMBER:       

EXPIRY:   

AGREEMENT TO PAYMENT OF $18 

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