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High Holy Days Service Participation Form

Your name

Names of immediate family members who will be participating with you:

Please select ALL SERVICES in which you'd be available to participate:

	Erev Rosh Hashanah (Friday, September 18)
	Rosh Hashanah Morning (Saturday, September 19)
	Erev Yom Kippur (Sunday, September 27)
	Morning Yom Kippur (Monday, September 28)
	Afternoon Yizkor/Memorial Services (Monday, September 28)

Please select how you'd prefer to participate:

	Reading part in Hebrew (transliterated) or English
	Reading part in Hebrew - Torah or Haftarah
	Reading part in English only
	Non-reading part (candle lighting, carrying Torah, etc.)
	Any of the above is fine by me

Please Note: Afternoon Yizkor/Memorial services
If you chose Afternoon Yizkor/Memorial services, opportunities may include candle lighting, reading from a prayerbook, or personal reading (to be discussed with Rabbis)

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

For added Security please check the box below.

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Please contact the Congregation Temple Israel Office at (324) 432-8050 if you have any questions or comments about the PAYQUIQ service or about payments.

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