THIS FORM IS NOT ACTIVE! Simchat Torah Form I'd like to attend the Simchat Torah on Monday, October 21 at (6:00 pm for children and) 7:00 PM for adults at the Chabad Aleph House Suggested Donation: $18 per Adult/$15 per child (Under 4 is free) How many ppl? $50 per Family Sponsor a family- How much? $ Other Information: * Denotes required field Title* Chaplain Dr. Dr. & Mrs. Drs. Mr. Mrs. Ms. Mr. & Mrs. Rabbi Rabbi & Mrs. The Honorable First Name* Last Name* Address* City* State Post Code* Country* Phone This is my home business address. Total to charge my card: Card Type* Visa Master Card American Express Discover Diners Club Card Number* Expiration Date* 01 02 03 04 05 06 07 08 09 10 11 12 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 CVV Security Code Email Address* Reconfirm Email Address* Please contact me to discuss additional giving opportunities. Recurring donation: Please charge the above amount to my credit card each month for the next twelve months. This page uses 128 bit SSL encryption to keep your data secure.