About You:
First Name: *
Last Name: *
Phone: *
E-Mail: *
Address: *
Country: *
State:
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City: *
Zip: *
Number of people you are registering for - Adults:

*

Children:

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Total Amount:
   
Program or Class Info:
Program or Class you are registering for:

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How did you hear about this event or program:

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Chabad's policy is that no one will be turned down due to lack of funds
For other options please call 860-232-1116 or email JewishLearning@ChabadHartford.com

Method of Payment:

Please make checks payable to:
Chabad House

2352 Albany Avenue
West Hartford CT 06117

Will send Check or Cash Credit

Credit Card Info:
First Name:
Last Name:
Address:
City, State and Zip:

Card Type
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Expiration Date: (mm/yyyy)
Security Code:

(Last 3 digits on back of card)