RESERVATION FORM

Number
of Tickets		 Events Price
Rosh Hashanah Services FREE
Luncheon $10.00
Yom Kippur Services FREE
Break-Fast Lox Dinner $25.00

Sorry I cannot attend services but I'd like to donate $   

Total cost: $

Name:
Mailing Address:
City/State/Zipcode:
Phone Number:
Fax Number:
Email Address:

If you select to charge the total amount to your credit card account, please provide your credit information.

VISA /MC Number:
Expiration Date:
Name appearing on card:
Signature: _______________________________

ALL RESERVATIONS Must be made by SEPTEMBER 1st and  and are not refundable.

Please print out this page and mail or fax to:

JDCC
1317 San Fernando Blvd #320
Burbank, CA 91504

FAX Number: 818/845-9936

If you mail a check, please make it payable to JDCC.

All services are held at: 507 Bethany Road Burbank, CA (FWY 5 at Burbank Blvd.)