Welcome to our High Holiday Seat/Membership Registration/Renewal Form Please submit this form by 4 September 2022 Full Name* First Name Last Name Phone Number Area Code Phone Number E-mail* Please enter names of persons you wish seats to be allocated for this year Person 1 First Name Last Name Person 2 First Name Last Name Person 3 First Name Last Name Person 4 First Name Last Name Person 5 First Name Last Name Person 6 First Name Last Name Person 7 First Name Last Name Person 8 First Name Last Name I do not wish to have seats allocated for me this year. I understand that my seats from previous years may be permanently allocated to others on the waiting list Payment Options Regular seat: $595. Student/Pensioner: $495. OPTION 1: I would like to pay the full amount now $ AUD OPTION 2: I would like to pay the full amount in monthly installments. 3 months 6 months 9 months 12 months Payment* Credit Card Bank Transfer Credit Card Visa MasterCard Credit Card Type Credit Card Number Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Expiration Year Account Name: Chabad House Glen Eira BSB: 033169 Account No: 186518 Reference: Surname - Seats Comments Submit Should be Empty: This page uses TLS encryption to keep your data secure.