Full Name* Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Phone Number E-mail* I would like to sponsor $360 Ensure every Jew has what they need for the High Holidays $500 Honor a loved one with a Memorial Board Plaque $500 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 Other $ Payment Credit Card Paypal Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code 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 Paypal has been selected. Payment will take place on the next page. Checks can be mailed to Chabad: 127 McDowell Street Asheville, 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.