Full Name*First NameLast NameE-mail*Phone Number*Area CodePhone NumberNumber of adults attending:*$36/adultNumber of children/teens attending:$18/child and teenPlease List Names of Attendees*Total$0.00Payment*Credit Card Paypal Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearPaypal has been selected. Payment will take place on the next page.Checks can be mailed to Chabad: 127 McDowell Street Asheville, NC 28801Billing AddressStreet 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 SaharaYemenZambiaZimbabweOtherCountryQuestion/Comment:Waiver:*Yes! I acknowledge: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.SubmitShould be Empty: This page uses TLS encryption to keep your data secure.