Shabbat Purim@WHC -
Purim Goes Pop!
Friday, March 14
CONTACT INFORMATION
First Name
Last Name
Phone Number
Email Address
Additional adults?
Children?
ADDITIONAL ATTENDEE INFORMATION
First Name
Last Name
TOTAL ATTENDEES
REGISTRATION
What are the general ages of the children?
Babies & Toddlers
Preschool
Elementary School
Middle School
High School
Please select all that apply
You are welcome to join us for any and all parts of the night. To help us plan, please let us know what parts of the evening you plan to attend.
When will you join us? (NOTE: Purim Carnivals have separate registrations)
5:00 pm — Tot Shabbat & Family Dinner
6:00 pm — Pre-Oneg with Purim Activities
6:30 pm — Shabbat Purim Service
After Service — Purim Oneg with Activities
Please select all that apply
Have you registered for the Purim Carnival for Families with Young Children on Saturday, March 15, 4:00 pm, JBSC?
REGISTER
Have you registered for the Purim Carnival on Sunday, March 16, 12:00 pm, JBSC?
REGISTER
Have you signed up to volunteer at either of our Purim Carnivals on March 15 & 16 at JBSC?
REGISTER
Are you WHC members?
Yes
No
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Zip Code
Would you like to learn more about Washington Hebrew?
Yes please!
No thank you
Wonderful! Our Director of Member Engagement, Jen Millstone, will be in touch soon.
How did you hear about this event?
Facebook
From a Friend
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WHC e-newsletter
WHC Journal
WHC Member
WHC's Shalom TV
WHC's Website
Other
Please select all that apply
Please provide the member's name
If "other" please explain
ACCOMMODATIONS
Do you need any accommodations to allow full participation in this event?
Yes
No
What accommodations do you need?
ADDITIONAL DONATION
Would you like to make a donation to the Lewis S. Wiener Annual Fund supporting the Temple's greatest financial need?
Enter the amount below.
$
This donation is from:
Refund policy
PAYMENT METHOD
How would you like to pay your bill?
Credit Card (includes 3% fee)
ACH (Direct Bank Debit - No fee)
CREDIT CARD INFORMATION
To help defray some of WHC's credit card processing costs, a 3% fee has been added to your credit card payment. Please note that ACH payments do not include this fee.
Fee Amount
$
Grand Total
$
First Name on Card
Last Name on Card
Credit Card Number
Expiration Month
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01
02
03
04
05
06
07
08
09
10
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12
Expiration Year
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2025
2026
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2035
CVV
Different billing address?
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No
Yes
Billing Street
Billing City
Billing State
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Alaska
Arizona
Arkansas
California
Colorado
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Delaware
District Of Columbia
Florida
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Hawaii
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Billing Zip Code
ACH INFORMATION
Bank Routing Number
Bank Account Number
Bank Account Type
Checking
Savings
Bank Name
Account Holder's Name (
NOTE: If this is a joint account, use one name only. If it's a trust/foundation use one first/last name only
)
Different billing address?
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No
Yes
Billing Street
Billing City
Billing State
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Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Billing Zip Code
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