November 11, 2010 • 7:00 PM At Suffolk YJCC • 74 Hauppauge Rd, Commack Cost: $15 • Student: $10 • Event Sponsor: $100 Space limited - RSVP Below Reservations Last Name State First Name Zip Address Phone City Email How many attending 0 1 2 3 4 5 6 7 8 at $15 Students 0 1 2 3 4 5 6 7 8 at $10 Yes! I'd like to be an event sponsor for $100 Payment Cost: $15 • Student: $10 • Event Sponsor: $100 I will mail my check to Chabad of Mid-Suffolk Please charge my Credit Card below CC Type Please Select Visa Mastercard American Express Discover Card # Charge Amt. $ Exp. Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2010 2011 2012 2013 2014 CVV Comments