Holy O'Blossom's Presents: Pub Night Purim (for Teens and Adults)
Thursday, March 13, 2025
8:00 - 10:00 PM
@ Holy Blossom Temple
Registration Information
Pronouns
Please select...
She/her
He/him
They/them
No pronouns, just my name
Other
Please specify
First Name
Last Name
Why are we asking for pronouns?
https://urj.org/quick-guide-pronouns
Email Address
Age
Adult
Teen (13+)
Are you a member at Holy Blossom Temple?
Yes
No
Are you affiliated with another congregation?
Yes
No
Congregation Name
Please send me information about membership at Holy Blossom Temple
How many additional guests will be joining you?
Please select...
0
1
2
3
4
5
1. Name
Age
Adult
Teen (13+)
2. Name
Age
Adult
Teen (13+)
3. Name
Age
Adult
Teen (13+)
4. Name
Age
Adult
Teen (13+)
5. Name
Age
Adult
Teen (13+)
I would like to make a contribution to programming at
Holy Blossom Temple
Contribution Details
Total Contribution
$
Please help us to offset credit card processing fees by contributing an additional 3%
Yes
No
Adjusted Total
3% Fee
$
Total Contribution
$
Please list your name(s) as you would like them to appear in the Temple Bulletin or write ‘anon’ if the gift is anonymous.
Credit Card Information
First Name
Last Name
Billing Address
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Billing Province
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OR
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Billing Postal Code
Billing address must match the address associated with the credit card.
Credit Card Number
Visa or Mastercard
Expiry Month
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1
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Expiry Year
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2025
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Tax Receipting
All donations will be tax receipted in February of the following year by email
Tax receipts will be issued for donations of $18 or more
Invoice Name
Num adults
Authnet_Hidden_Fields
Invoice req'd
Yes
No
Final Contribution
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