Full Name* First Name Last Name E-mail* Phone Number* Area Code Phone Number Please select the services you would like to attend: Rosh Hashanah Sep 22 (Mon) - Evening Services (6:45 PM)Sep 22 (Mon)- Community Dinner (7:15 PM)Sep 23 (Tue) - Morning Service (10:00 AM followed by a Kiddush)Sep 23 (Tue) - Children's Program (11:00 AM- 12:00 PM)Sep 23 (Tue)- Shofar & Tashlich at the pond (6:00 PM)Sep 24 (Wed) - Morning Service (10:00 AM) Adults $36 per person Children $10 per child Yom Kippur Oct 1 (Wed) - Kol Nidrei Evening Services (6:15 PM)Oct 2 (Thu) - Morning Service (10:00 AM)Oct 2 (Thu)- Afternoon Neila Service (5:00 PM)Oct 2 (Thu)- Break-fast (7:14) PMJust Adding Names For Yizkor Book Number of Registrants* 123456 Please include the names of the people attending with you Donations and Yizkor Book Yizkor Donation Amount* I don't have names for Yizkor BookNo Donation Per Name1 Name ($18)2 Names ($36)3 Names ($54)4 Names ($72)5 Names ($100)More than 5 Names ($100)Choose my Own Amount - see next section Please include all names as you want them in the yizkor book Chabad offers High Holiday services at no charge to the community. As always our services are without charge and participation is voluntary, but in light of the increased costs, we are encouraging and requesting your financial participation. Please consider the suggested donation of $100 per adult and $50 per child and young adult or consider being a High Holiday superstar with a High Holiday sponsorship. Would you like to make an additional donation? I would like to make a donation.Not at this time. Select a Choice $180 - Sponsorship$360 - Family Sponsorship$720 - Shana Tova Sponsorship$1,8000 - High Holiday Superstar SponsorshipEnter your own Superstar donation Enter your own amount $ Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 2.6% Payment Credit Card Paypal eCheck Check or Zelle:Rabbi@ElginChabad.com Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearPaypal has been selected. Payment will take place on the next page. Bank Name Routing Number Account NumberCheckingSavingsBusiness Account TypeBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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