- Form - Temple Am Echad The South Shore Reform Congregation

* Preferred Email Address

* First Name

* Last Name

Guest Name/s

Number of Adult Temple Members ($15 per adult)

Number of Children ($5 per child ages 6-12)

Number of Families ($35 cap per family)

Number of Children (children 5 and under are free)

Number of Guest Adults ($30 per adult)

Total Amount

Please Bill Me (Temple Members only)

If paying by check, please make your check payable to Temple Am Echad and mail to:
One Saperstein Plaza, Lynbrook, NY 11563 - Thank you.

For credit card payments, please complete the fields below
Note: Credit card payments are subject to a 3% surcharge

Please charge

To my credit card

VisaMasterCard

Credit card #

Name on Credit Card

Expiration Date

CVV (3-4 digits)

If not a member of Temple Am Echad, please provide your address and phone number here

Sat, September 30 2023 15 Tishrei 5784