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Purim Reservation F orm

A Celebration for the Entire Family

Featuring a interactive world famous CHINESE ACROBATS SHOW
» Live Music & Dancing, Entertainment & Food,
» Door-Prizes for attendees in costume!
» Special Kids show and games!
» Hamantashen & Lchaim!


SATURDAY MARCH 11, 2017, 7:30 pm at the Rubie Plaza, 400 Broad Hollow Rd,


Last Name   State
First Name   Zip
Address   Phone
City   Email
Purim at Rubie Plaza   Optional Sponsorship

Adults Children

$10 per person


Amount $
(Sponsor $180 or $360 and your name will be mentioned at the event)

Adults     Children  
Adult Name 1   Child Name 1
Adult Name 2   Child Name 2
Adult Name 3   Child Name 3
Adult Name 4   Child Name 4
Adult Name 5   Child Name 5
Adult Name 6   Child Name 6



I will mail my check to the Melville Chabad Center
Please charge my Credit Card
CC Type   Card #

Exp Date


Year Month



Card Zip Code
Total Charge Amt.


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