Purim Fiesta | www.jewishtemecula.com

Your Registration Info

First Name *

Last Name *

Email Address *

Event Fee(s)

Early Bird Adult Fee *

$23.00
Enter number of adults

Early Bird Child Fee - 12 and under

$15.00
Enter number of children

Total

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province

Postal Code