Reservation and Order Form

Deadline: Sunday, March 25

For more information call 845-356-6686 or email


General information

First Name: Last Name:


Address: City: State: zip:


Email: Phone:



Reservation information

Number of Adults Number of Children

Name of attendees

We plan on attending the Holiday Service on Saturday, March 31 at 10:00 am (No Fees)

We plan on attending the Holiday Service on Sunday, April 1 at 10:00 am (No Fees)

Please arrange for the sale of our Chametz


We would like to order lbs. of Handmade Shmura MAtzah @ $20 per pound


Payment information

Passover Campaign Sponsor: $1800

Seder Sponsor: $360

Adult: $50

Children (ages 3 - 12): $25 

If a financial hardship exists, please contact the rabbi @

Total payments

Card Type Card Number

Expiration Date CVV Security Code

Please check that all information including payment amount is correct before submitting your form.