Bingo, Barter & Brew - Form - Beth Shalom Congregation

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Bingo, Barter & Brew

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Bingo, Barter & Brew

February 25, 2023 at 7:30 p.m.

* Registrant 1 First Name

* Registrant 1 Last Name

* Registrant 1 Email

* Registrant 1

Please Select OneBeth Shalom memberBeth Shalom non-member

Would you like to add another registrant?

No, I'd like to continue to payment optionsYes

Registrant 2 First Name

Registrant 2 Last Name

Registrant 2 Email

* Registrant 2

Please Select OneBeth Shalom memberBeth Shalom non-member

Would you like to add another registrant?

No, I'd like to continue to payment optionsYes

Registrant 3 First Name

Registrant 3 Last Name

Registrant 3 Email

Registrant 3

Beth Shalom memberBeth Shalom non-member

Would you like to add another registrant?

No, I'd like to continue to payment optionsYes

Registrant 4 First Name

Registrant 4 Last Name

Registrant 4 Email

Registrant 4

Beth Shalom memberBeth Shalom non-member

Babysitting is available for children ages 4 and older.
$5/child to help cover the cost of the babysitters and snacks!

Do you need babysitting for this program?

NoYes

First Name

Last Name

Age

Do you need babysitting for an additional child?

NoYes

First Name

Last Name

Age

Do you need babysitting for an additional child?

NoYes

First Name

Last Name

Age

Emergency Contact Name for child(ren) in babysitting

Emergency Contact Phone for child(ren) in babysitting

Emergency Contact Relationship for child(ren) in babysitting

Additional monetary donation to support the Bingo, Barter & Brew Fundraiser.

Mon, January 30 2023 8 Shevat 5783

Beth Shalom Congregation

8070 Harriet Tubman Lane

Columbia, MD 21044

410.531.5115 | www.beth-shalom.net

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