Shabbat Dinner Reservations

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Use this form to reserve and pay for your spot at our next Shabbat Dinner. We so look forward to celebrating Shabbat with you!

Date of dinner(Required)

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Date of dinner

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Name for reservation(Required)

First Last

Email(Required)

Cellular Phone(Required)

Home Phone

Names of additional people in your group

First

Last

Age if < 18

Use the '+' at the right to add more lines; one per person

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List Counter

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Total people

Address(Required)

Street Address City State ZIP Code

Full address including State and ZIP Code please

Are you, or is someone in your party celebrating a birthday or anniversary this month?

Birthday

Anniversary

Details of the : Who and when?

Membership Status

Are you a current member of ICCJ?(Required)

Yes

Not yet

Photo ID(Required)

Please upload clearly visible photo ID(s) of all adults in your party, for our security team.

Drop files here or

Accepted file types: jpg, png, pdf, tiff, gif, Max. file size: 300 MB.

☞ Please indicate your membership status before proceeding with your meals selection

Meal choices

👪 Please note: Cost should not deter you from joining us. If you find it onerous, kindly confidentially contact the rabbi.

Adult Chicken

Price: $30.00

Adult Fish

Price: $30.00

Adult Vegan

Price: $30.00

Adult Chicken

Price: $35.00

Adult Fish

Price: $35.00

Adult Vegan

Price: $35.00

Youth 13-18 years old Chicken

Price: $13.00

Youth 13-18 years old Fish

Price: $13.00

Youth 13-18 years old Vegan

Price: $13.00

Child 5-12 years old Chicken

Price: $9.50

Child 5-12 years old Fish

Price: $9.50

Child 5-12 years old Vegan

Price: $9.50

Child 0-4 years old

Price: $0.00

Discount

Price: $0.00

Complimentary

Price: $0.00

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Adult Chicken Meals

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Adult Fish Meals

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Adult Vegetarian Meals

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BAdult Chicken Meals

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BAdult Fish Meals

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BAdult Vegetarian Meals

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Youth Chicken Meals

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Youth Fish Meals

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Youth Vegetarian Meals

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BYouth Chicken Meals

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BYouth Fish Meals

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BYouth Vegetarian Meals

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Child Chicken Meals

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Child Fish Meals

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Child Vegetarian Meals

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Children < 5 y.o.

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BChild Chicken Meals

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BChild Fish Meals

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BChild Vegetarian Meals

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BChildren < 5 y.o.

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Total adults:

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Total youth:

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Total children ≥ 5:

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Total children < 5:

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Total people:

Allergies or restrictions we should be aware of?

Payment

Subtotal

Optional add 3%

Optional: Add 3% to cover our credit card processing fees

3% added to cover CC processing fees

Price: $0.00

Total

OFFICE: type OVERRIDE to submit without payment

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Same as above

Email associated with Card(Required)

Phone Number Associated With Card(Required)

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Shabbat Dinner Reservations

Sign up below flyer!

Membership Status

☞ Please indicate your membership status before proceeding with your meals selection

Meal choices

Payment

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