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Jewish Womens Circle Online Form

Jewish Womens Circle Online Form

ILLUMINATE YOUR LIFE a Shabbat and Art Workshop

Cost is $20 per person. 

First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State
Post Code*
Country
Phone
Email Address

Please charge my Credit Card

I will mail in a check for this amount. 

 I'd like to pay with Paypal (check the button at the beginning of the line then CLICK HERE to be re-directed to our paypal page and THEN hit submit at the end of this form.)

Card Type
Card Number

ExpDate(MM/YYYY)

Name On Card

 

 

CVV CODE 3-4 digit Security Code
 
I need a paper receipt. Email is not enough

 

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