Kapparot - ChabadBronx.org

I contribute the amount below to the Chabad Kapparot Fund so that it be an atonement for my family and myself. In this merit may we be inscribed and sealed in the book of life.
Number of people doing Kapparot in person: $20/person
Number of people doing Kapparot online: $20/person
Additional Donation:

$50$100$180$360
Full Name*

First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
Please include the Hebrew Name and Mother's name of each member of your family for those doing Kapparot online.
Your Hebrew Name

Hebrew Name Mother's Hebrew Name
Spouse's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Child's Hebrew Name

Hebrew Name Mother's Hebrew Name
Total

$0.00

Payment

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Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

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Country

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