English form korban pesach

Membership Details

Family Name ______________________________

Head of family ______________________________

Members of family (including women and children who can eat meat)

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Name __________________  age __________

Address _________________________________________________________

________________________________________________________________

Phone number _________________________  Cel ___________________________

Email _________________________________________________

Credit card info - Card Number ____________________________________________

Expiration date __________________    ID of Card owner ________________________

12 NIS  (3$) per person

לגירסת הדפסה