DID YOU RENEW YOUR CHABAD OF GREAT NECK MEMBERSHIP FOR 2026-2027* YESNO (this discount is for members only become a member at www.chabadgn.com/member) 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 E-mail* Phone Number* Area Code Phone Number Cell Number* Area Code Phone Number I would like to receive news and updates by email Would like to sit with: Names of people attending: ROSH HASHANA DINNER & SIMANIM 1st Night of Rosh Hashana, Friday Evening , Sep .11 2nd Night of Rosh Hashana, Shabbat Evening , Sep .23 Both Nights: 6:30 PM services 7:30 PM Gourmet Dinner COST FOR MEMBERS ONLY: First night: Free for the first 4 people - after that its $50 per adult and 40 per child Second Night: $65 per Adult and $45 per Child SPACE IS LIMITED NO CANCELLATIONS | NO REFUNDS Dinner Attending (check all that apply)* Both NightsFirst NightSecond Night FIRST NIGHT SEATS What members are coming free (up to 4 free) * Adult Seat 1st NIGHTAdult Seat 1st NIGHTAdult Seat 1st NIGHTAdult Seat 1st NIGHTChild Seat 1st NIGHTChild Seat 1st NIGHTChild Seat 1st NIGHTChild Seat 1st NIGHTAdult Seat 2nd NIGHTAdult Seat 2nd NIGHTAdult Seat 2nd NIGHTAdult Seat 2nd NIGHTChild Seat 2nd NIGHTChild Seat 2nd NIGHTChild Seat 2nd NIGHTChild Seat 2nd NIGHT If more than 4 seats are needed the first night fill out below, If not skip to choose for the second night seats How many additional ADULT seats first night only ($65 per seat) How many additional CHILD seats first night only ($45 per seat) If more than 4 seats are needed the second night fill out below How many additional ADULT seats second night only ($65 per seat) How many additional CHILD seats second night only ($45 per seat) Donate to the needy for the High Holidays(this will be added to the final amount to charge) Total $0.00 NO CANCELLATIONS | NO REFUNDS Terms and Conditions* I, the undersigned agree, understand and authorize the amount shown above to be charged to my credit card for the items shown on the referenced order. 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