Full Name* First Name Last Name Address Street Address Street Address Line 2 City State / Province Postal / 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 SaharaYemenZambiaZimbabweOther Country Phone Number Number of Adults Number of Children E-mail Please check the services that you will be attending: Rosh Hashana Evening - ServiceRosh Hashanah DinnerRosh Hashana 1st Day - Morning Services, Sermon & ShofarRosh Hashana 1st Day - Family Service, TashlichRosh Hashana 2nd Day - Morning Services, Sermon & ShofarYom Kippur Kol Nidrei ServiceYom Kippur Prayer Service, Torah Reading & YizkorYom Kippur Neilah - Mincha & Closing Service I would like to sponsor $180 High Holiday Contribution$360 Dedicate a set of Rosh Hashana/Yom Kippur Machzorim$500 Honor a loved one with a Memorial Board Plaque$720 Break-the-Fast co-sponsor$1,000 High Holiday Partner$1,800 High Holiday Friend$3,600 Chai Sponsor$5,400 High Holiday Presenting Sponsor$10,000 High Holiday Underwriter Payment Credit Card Paypal Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPaypal has been selected. Payment will take place on the next page.Checks can be mailed to Chabad: 127 McDowell StreetAsheville, NC 28801 Total $0.00 Questions/Comments: I acknowledge the highly contagious nature of COVID-19 and I voluntarily assume the risk that I and members of my party could be exposed or infected by COVID-19 by participating in any of Chabad-Lubavitch WNC's High Holiday programs. I declare that I and members of my party are participating voluntarily in Chabad-Lubavitch of WNC's High Holiday programs. If I or anyone in my household or any member of my party or anyone in their households experience any cold or flu-like symptoms (including fever, cough, sore throat, respiratory illness, difficulty breathing), I and/or members of my party will not attend any of Chabad-Lubavitch of WNC's High Holiday programs until at least 14 days have passed since those symptoms were last experienced. If I or any member of my household, or any member of my party or their household members travelled to or had a lay-over in any country outside of the United States, I and/or members of my party will not attend any of Chabad-Lubavitch of WNC's High Holiday programs until at least 14 days have passed since the aforementioned traveller returned home. I and all members of my party agree to observe and abide by the requirements and policies of Public health and other governmental authorities and to those special safety regulations put in place by Chabad-Lubavitch WNC. I and all members of my party agree that by submitting this form we are giving up our legal rights to sue or make any claim whatsoever against Chabad-Lubavitch WNC and its officers and directors, in the event that I or any member of my party contracts the Covid-19 Coronavirus. I understand that members of the same gender in my party will be seated together as members of the same household with social distancing between my party and other parties but not between members of my party. Submit Should be Empty: This page uses TLS encryption to keep your data secure.