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TBT High Holiday Registration for Non-Members (2023)
GENERAL INFORMATION
Please select the number of persons you are registering for below.
# of Adults (18 and older)
(Required)
Select
1
2
3
4
Children (Ages 13 to 17)
Select
1
2
3
4
5
Children (Ages 6 to 12)
Select
1
2
3
4
5
Children (Ages 5 and Under)
Select
1
2
3
4
5
Do you plan to attend Family Services ONLY?
(Required)
Yes
No
How did you hear about Temple Beth Torah?
(Required)
A TBT Member
A TBT Rabbi
Facebook
Jewish Website
Print Ad
Other
GUEST INFORMATION
Please provide YOUR name and contact information.
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Primary Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
For security purposes, please provide the names and contact information for all ADULTS planning to attend High Holidays with you.
Adult 2 - FULL NAME
(Required)
Adult 2 - EMAIL ADDRESS
(Required)
Adult 2 - PHONE
(Required)
Adult 2 - ADDRESS
(Required)
Same as previous
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Adult 3 - FULL NAME
(Required)
Adult 3 - EMAIL ADDRESS
(Required)
Adult 3 - PHONE
(Required)
Adult 3 - ADDRESS
(Required)
Same as previous
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Adult 4 - FULL NAME
(Required)
Adult 4 - EMAIL ADDRESS
(Required)
Adult 4 - PHONE
(Required)
Adult 4 - ADDRESS
(Required)
Same as previous
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
SERVICE ATTENDANCE
Please indicate which services you/your group plan to attend by entering the TOTAL number of persons (adults and children) for each service below. This information assists us with planning and security.
EREV ROSH HASHANAH SERVICE - Sept. 15 at 7:30pm
Select
1
2
3
4
5
6
7
8
9
10
ROSH HASHANAH FAMILY SERVICE - Sept. 16 at 9am
Select
1
2
3
4
5
6
7
8
9
10
ROSH HASHANAH MORNING SERVICE - Sept. 16 at 10:15am
Select
1
2
3
4
5
6
7
8
9
10
KOL NIDRE SERVICE - Sept. 24 at 7:30pm
Select
1
2
3
4
5
6
7
8
9
10
YOM KIPPUR FAMILY SERVICE - Sept. 25 at 9am
Select
1
2
3
4
5
6
7
8
9
10
YOM KIPPUR MORNING SERVICE - Sept. 25 at 10:15am
Select
1
2
3
4
5
6
7
8
9
10
YOM KIPPUR PM/N'ILAH SERVICES - Sept. 25 at 4/5:15pm
Select
1
2
3
4
5
6
7
8
9
10
REGISTRATION COSTS
Temple Beth Torah welcomes non-members to attend High Holiday services with our community for $175 per adult per holiday or $300 per adult for both holidays. Family Services are free of charge for both adults and children.
# of Adults (18 and older) for BOTH Holidays
Price:
$300.00
Quantity:
# of Adults (18 and older) for Rosh Hashanah ONLY - Sept. 15 & 16
Price:
$175.00
Quantity:
# of Adults (18 and older) for Yom Kippur ONLY - Sept. 24 & 25
Price:
$175.00
Quantity:
BREAK-THE-FAST - Monday, Sept. 26 approx. 6pm
TBT hosts a Break-the-Fast following N'ilah on Yom Kippur. Please indicate any dietary needs below so we have appropriate options for everyone.
# of Adult(s) (18 and older) for Break-the-Fast
Price:
$30.00
Quantity:
# of Children (ages 13 to 17) for Break-the-Fast
Price:
$20.00
Quantity:
# of Children (ages 6 to 12) for Break-the-Fast
Price:
$15.00
Quantity:
# of Children (5 and under) for Break-the-Fast
Price:
$0.00
Quantity:
Dietary Needs
Please select all that apply.
Dairy Free
Gluten Free
Vegetarian
Vegan
Other
Food Allergies
Please select all that apply.
Peanuts
Tree Nuts
Milk or Dairy
Other
If you selected "Other" for Dietary Needs or Food Allergies, please specify below:
ADDITIONAL CONTRIBUTIONS
TBT is a small and vibrant community. We welcome and appreciate additional contributions of any amount to support our congregation.
I would like to contribute
Chai
Double Chai
Quadruple Chai
Other
Not at this time
If other, please list amount below:
YIZKOR INFORMATION
TBT publishes a Yizkor memorial booklet which is provided during the Yizkor service.
Would you like to remember someone in the Yizkor booklet and during the Yizkor service?
(Required)
Yes
No
1. In Loving Memory of
(Full English Name)
1. Relationship to You
(Mother, father, etc.)
1. Date of Passing
MM slash DD slash YYYY
(English Date)
1. After Sundown?
Yes
No
Unknown
2. In Loving Memory of
(Full English Name)
2. Relationship to You
(Mother, father, etc.)
2. Date of Passing
MM slash DD slash YYYY
(English Date)
2. After Sundown?
Yes
No
Unknown
3. In Loving Memory of
(Full English Name)
3. Relationship to You
(Mother, father, etc.)
3. Date of Passing
MM slash DD slash YYYY
(English Date)
3. After Sundown?
Yes
No
Unknown
SUMMARY AND PAYMENT
PREFERRED PAYMENT METHOD
(Required)
Credit Card
Check
TOTAL AMOUNT DUE
Price:
$0.00
To pay by credit card, please click
HERE
, enter the total amount due, and check the box to cover the fees (we appreciate it).
MAKE SURE TO CLICK SUBMIT ON THIS FORM AFTER COMPLETING PAYMENT
FOR PAYMENT BY CHECK, please include "High Holidays 2023" on the note line and make your check payable to TEMPLE BETH TORAH.
Please mail your check to:
TBT HIGH HOLIDAY COMMITTEE
PO BOX 2020
CENTREVILLE, VA 20122
Δ
