Tikkun Leil Shavuot 5786 Dinner Registration

If you are attending Tikkun Leil Shavuot in person, please use the form below to register for dinner. If you cannot make it in person but wish to attend via Zoom, please click here to sign up to receive the Zoom information.

Registration Information

First Name

Last Name

Email:

Address

City

State

Zip Code

Ticket Information

Number of Attendees

at $12 each

Total Amount Due:

Please list the names of all attendees.

Please select a payment method:

Credit CardACH/eCheck

Electronic Check (ACH) Payment

Bank Routing Number	Bank Account Number
Bank Account Type	Bank Name
Account Holder Name

There is a 3% transaction fee for paying by credit card. There is no fee for paying by eCheck.

I understand and agree to the 3% transaction fee.

3% Fee Information

Fee

New Total

Credit Card Payment

Credit Card Number

Verification Code

Card Expiration (Month)

Card Expiration (Year)

Use a different billing address?

Billing Street

Billing City

Billing State

Billing Zip Code

Please click the Submit button only once to avoid being charged multiple times.
The form can take up to 1-2 minutes to process.

% Fund

% Fee

Authnet_Hidden_Fields