Yes - I would like to attend Purim at Circus with the Twins from France!

First name: Last name:

Number of adults: Number of children:

Address: City:

Zip Email:

Name as it appears on card (if different than above):

Type of card:

Card number:

Expiration: Security code:

Billing address: (if different than above)

Address: City:


I authorize Chabad of Tidewater to charge $ to my card. ($18 per person, until February 22, $25 at the door - $360 sponsorship)

If you wish to RSVP without a credit card, please mail your check to Chabad of Tidewater at 1920 Colley Ave, Norfolk, VA 23517