Prime Timers' Shabbat Dinner with Rabbis Sisenwine and Dafna-Kellen

Friday, December 6, 2024 | Following services

Join us immediately following Shabbat services.

____________________________________________________

Thank you for your interest in the Prime Timers' Shabbat Dinner with Rabbis Sisenwine and Dafna-Kellen. This form is currently closed. Please reach out to Susan Karon at skaron@tbewellesley.org with questions.

TBE Form Password:

REGISTRATION

Are you a TBE Member?

YesNo

Number of adults attending:

Number of adult members attending:

Number of adult non-members attending:

First Name

Last Name

Mobile Phone

Primary Email

First Name

Last Name

Mobile Phone

Primary Email

CUSTOM QUESTIONS

Are you age 65 or older?

Yes

How will you be attending?

In PersonOnline

Will you be taking the bus?

Yes

I would be interested in carpooling with TBE

Yes

TOT SHABBAT DATES

We would like to register for the following dinners:
You can always come back to this form and register for additional dinners in the future!

Month X1, 202X: 5:30pmMonth X2, 202X: 5:30pmMonth X3, 202X: 5:30pmMonth X4, 202X: 5:30pmMonth X5, 202X: 5:30pmMonth X6, 202X: 5:30pmMonth X7, 202X: 5:30pmMonth X8, 202X: 5:30pm

NUMBER OF CHILDREN ATTENDING

Number of youth members attending:

Number of youth non-members attending:

Number of children attending:

First Name (Child #1)

Last Name (Child #1)

Grade (Child #1)

Age (Child #1)

First Name (Child #2)

Last Name (Child #2)

Grade (Child #2)

Age (Child #2)

First Name (Child #3)

Last Name (Child #3)

Grade (Child #3)

Age (Child #3)

First Name (Child #4)

Last Name (Child #4)

Grade (Child #4)

Age (Child #4)

First Name (Child #5)

Last Name (Child #5)

Grade (Child #5)

Age (Child #5)

First Name (Child #6)

Last Name (Child #6)

Grade (Child #6)

Age (Child #6)

First Name (Child #7)

Last Name (Child #7)

Grade (Child #7)

Age (Child #7)

First Name (Child #8)

Last Name (Child #8)

Grade (Child #8)

Age (Child #8)

First Name (Child #9)

Last Name (Child #9)

Grade (Child #9)

Age (Child #9)

SESSION CHOICES

Members

FallWinter Spring ISpring II

Non Members

FallWinter Spring ISpring II

PHOTO & VIDEO PERMISSIONS

I grant my permission to use any and all written comments, pictures, or video in which my child or I may appear for print, audio, visual, and/or electronic publicity promotion and advertising on behalf of TBE and its programs.

YesNo

DIETARY RESTRICTIONS & FOOD ALLERGIES

Please list any dietary restrictions and/or food allergies:

GENERAL & MEDICATION ALLERGIES

Please list any general allergies and/or allergies to medications:

MEDICAL CONDITIONS

Please list any medical conditions:

EMERGENCY CONTACT INFORMATION

Emergency Contact #1

Full Name

Mobile Phone

Primary Email

Relationship

Emergency Contact #2

Full Name

Mobile Phone

Primary Email

Relationship

DONATIONS

Please consider making a donation

BILLING INFORMATION

First Name*

Last Name*

Primary Email*

Mobile Phone*

Billing Street

Billing Unit/Apt.

Billing City

Billing State

Billing Zip Code

Is your mailing address the same as your billing address?

YesNo

Mailing Street

Mailing Unit/Apt.

Mailing City

Mailing State

Mailing Zip Code

Credit Card No.

Exp. Month

MM

Exp. Year

YYYY

Verification Code

Total

$

HIDDEN FIELDS

Form Requests Hidden Fields

FORM #1: ARE YOU A TBE MEMBER?

Yes

FORM #2: # OF ADULTS ATTENDING?

Yes

FORM #3: # OF ADULT MEMBERS ATTENDING?

Yes

FORM #5: # OF ADULT NON-MEMBERS ATTENDING?

Yes

FORM #6: ARE YOU 65 OR OVER?

Yes

FORM #7: HOW WILL YOU BE ATTENDING?

Yes

FORM #8: WILL YOU BE TAKING THE BUS?

Yes

FORM #9: I WOULD BE INTERESTED IN CARPOOLING

Yes

FORM #10: TOT SHABBAT DINNERS

Yes

FORM #11: # OF CHILDREN ATTENDING?

Yes

FORM #12: # OF YOUTH MEMBERS ATTENDING?

Yes

FORM #13: # OF YOUTH NON-MEMBERS ATTENDING?

Yes

FORM #14: SESSION SEASONAL BOXES FOR MEMBERS & NON-MEMBERS?

Yes

FORM #15: PHOTO & VIDEO PERMISSIONS?

Yes

FORM #16: DIETARY RESTRICTIONS & FOOD ALLERGIES

Yes

FORM #17: MEDICAL CONDITIONS

Yes

FORM #18: GENERAL/MEDICATION ALLERGIES

Yes

FORM #19: SUGGESTED DONATION

Yes

FORM #20: TBE Form Password

Yes

FORM #20: EMERGENCY CONTACT (NAME, PHONE NUMBER, EMAIL, RELATIONSHIP

Yes

General Hidden Fields

Event Space #1- Capacity

Event Space #2- Capacity

Financials Audit

Form - Financial Registration Total - Current Tally

Prefill - SF Capacity - Finance Registration Total - Currently Tally

Authnet_Hidden_Fields

reCAPTCHA helps prevent automated form spam.

The submit button will be disabled until you complete the CAPTCHA.