1. Your InformationFull Name*First NameLast NameAddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryPhone Number*Area CodePhone NumberE-mail*2. Seat ReservationsAmount Adult Attendees123456Amount of Children Attendees123456Which services will you attend? (Some things just cannot be Zoomed. Services will be in-person only)*Sep. 26 Pre-Yom-Kippur Zoom Program 7:45 pmSep. 27 Kol Nidrei services 6:30 pmSep. 28 Early Yizkor Service 9:30-10:00 amSep. 28 I will attend FULL Shacharit Services 10:00 am - 2:00 pmSep. 28 I will attend PART of Shacharit Services 10:00 am - 2:00 pmSep. 28 Mincha 5:30 pmSep. 28 Neilah 6:30 pmSep. 28 BreakFast to-go 7:30 pmNames of attendees. Any comments / seating preferencesI would like to purchase a Yom Kippur Machzor for $25$25$50$753. Optional DonationParticipation in all High Holiday programs is free. Consider a donation to help cover the costs of these and other wonderful and vital programs that Chabad of Arcadia brings to our community.Donation amount$50$100$240$580$800$1000$1800$3200Yes, I'd like to make this a monthly recurring payment.Total$0.00PaymentPaypal Check Paypal has been selected. Payment will take place on the next page.Mail to: Chabad of Arcadia, 617 W. Wistaria Ave. Arcadia, CA 91007 Payments can also be sent "fee-free" via Zelle to: [email protected]Please review our COVID-19 safety guidelines and policies.Safety Review*I have thoroughly reviewed Chabad of Arcadia's safety COVID-19 guidelinesSubmitShould be Empty: This page uses TLS encryption to keep your data secure.