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Program Chair: Anne Liebergall 

Reservations: 
Adults ($10):     Children ($5):    
Last Name   
First Name   
Address   
City/State/Zip   
  		 Phone   
Email   
Sponsorship Opportunities (includes family entry)

 ''Purim Sponsor'' $1000 

  ''Carnival sponsor'' $500  '' Megillah Sponsor'' $360
Payment Information:

Charge Amount  Card Type   
Card Number   
Expiration Date   
   		 Card Code   
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