Temp Forms 2021 Women’s Seder Registration Form Will you be joining us at the 2021 Women's Seder?* I am so excited! Please sign me up for the 2021 Women’s Seder Experience I’m bummed, I can’t attend this year, but would like to make a contribution so others may attend Are you a Sisterhood Member?* I am a Sisterhood Member (Woman of IHC) I am a guest Attendee DetailsName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Guest Registration? I would also like to register for someone else.Name(s) of Guest(s) Registered Person’s Email(s) What is your relationship to your guest(s)? Your ContributionThank you for your contribution to make this special event happen. May we suggest the following giving levels: Miriam’s Song: $72 Miriam’s Well $54 Miriam’s Timbrel: $36 Miriam’s Cup: $18 Contribution Amount* Guest Contribution Amount HiddenSwag Bag DetailsAll participants (who register by February 26 at midnight) will receive a Sisterhood Seder Swag Bag, please indicate:HiddenWould you like a Swag Bag? Yes No, thanks, save the expense and trouble No, thanks, I live out of the area HiddenDo you have any of the following dietary restriction needs? I am gluten free I have a nut allergy HiddenWould your guest(s) like a Swag Bag?(we suggest a minimum $18 contribution for each registered guest) Yes No, thanks HiddenDoes your guest(s) have any dietary restrictions? Please list: HiddenI’m excited about the Sisterhood Seder Swag Bag and plan to pick it up:Choose Pickup DateSunday, March 14 between 10am and noon during the Drive-thru pick-upMonday, March 15 @ Sisterhood Gift Shop, 10am-2pmWednesday, March 17 @ Sisterhood Gift Shop, 10am-2pmFriday, March 19 @ Sisterhood Gift Shop, 10am-2pmMonday, March 22 @ Sisterhood Gift Shop, 10am-2pmI am housebound and would appreciate delivery of the Swag Bag.<b>Only available in greater Indianapolis area.</b>Process Contribution PaymentYour contribution is securely processed.Credit CardThe Stripe Card field cannot work when the Payment Collection Method is set to Stripe Payment Form (Stripe Checkout).Total $0.00
