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Membership

Membership

SECURE ONLINE PAYMENT

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Welcome to our secure online payment system - pay online 24 hours a day, 6 days a week. It's that simple!

Simply fill out the form below and click the button to submit your payment.

*denotes a required field.

*Name:

*Email Address:

*Payment For Shul Seats:

(If you do not have the seat numbers please leave blank)

SHUL SEATS 2016
Adults School Age Children/
Pensioners

1. Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

2. Name : $595 $430

Male Female
Table No. OR Row No. and Seat No.

3. Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

4.Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

5. Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

6. Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

7. Name : $595 $310
Male Female
Table No. OR Row No. and Seat No.

8. Name : $595 $430
Male Female
Table No. OR Row No. and Seat No.

Children attending with no reserved seat:
9. Name : DOB: Age:
10. Name : DOB: Age:
11. Name : DOB: Age:
12. Name : DOB: Age:
13. Name : DOB: Age:


No. of Adults x $595.00:

No. of School Age Children / Pensioners x $430.00:
No. of Children with no reserved seat:

COSV LEVY x $25 (per seat)

CSG LEVY x $10 (per seat)

TOTAL $

Please Note:

*Method of Payment:

Type of

*Card Number:

*Expiration Month: *Year:

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