Full Name* First Name Last Name Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Phone Number* Area Code Phone Number E-mail* Kiddush Options Please choose one of the three options below, and choose your selections from the drop down menus of that option. Option 1 Dairy/Parave Kiddush $180 Bagels Lox Cream Cheese Pickles, Olives, Onion, Tomato Vegetarian Cholent with Kishka Kugel (Potato, Sweet Noodle, Butternut Squash/Pumpkin Pie) OR Pasta Salad (Sesame Noodles, Tomato Basil Pasta, Sweet Vinegar) Dip (Babaganoush, Olive, Red Pepper, Chummus/Techina, Dill) Fruit OR Babka OR Cake Kugel OR Pasta Salad Please make your selection from the drop down menu Please Select Potato - Kugel Sweet Noodle - Kugel Butternut Squash/Pumpkin Pie - Kugel Sesame Noodles - Pasta Salad Tomato Basil Pasta - Pasta Salad Sweet Vinegar - Pasta Salad Dip Please make your selection from the drop down menu Please Select Babaganoush Olive Red Pepper Chummus/Techina Dill Fruit OR Cake OR Babka Please make your selection from the drop down menu Please Select Fruit Cake Babka Option 2 Dairy/Parave Kiddush $180 Challah Rolls OR Bagels Gefilte Fish OR White Fish Salad Tuna Salad Egg Salad Pickles, Olives, Onion, Tomato Vegetarian Cholent with Kishka Kugel (Potato, Sweet Noodle, Butternut Squash/Pumpkin Pie) OR Pasta Salad (Sesame Noodles, Tomato Basil Pasta, Sweet Vinegar) Dip (Babaganoush, Olive, Red Pepper, Chummus/Techina, Dill) Fruit OR Babka OR Cake Challah Rolls OR Bagels Please make your selection from the drop down menu Please Select Challah Rolls Bagels Gefilte Fish OR White Fish Salad Please make your selection from the drop down menu Please Select Gefilte Fish White Fish Salad Kugel OR Pasta Salad Please make your selection from the drop down menu Please Select Potato - Kugel Sweet Noodle - Kugel Butternut Squash/Pumpkin Pie - Kugel Sesame Noodles - Pasta Salad Tomato Basil Pasta - Pasta Salad Sweet Vinegar - Pasta Salad Dip Please make your selection from the drop down menu Please Select Babaganoush Olive Red Pepper Chummus/Techina Dill Fruit OR Cake OR Babka Please make your selection from the drop down menu Please Select Fruit Cake Babka Option 3 Deli Kiddush $360 Challah Rolls Deli Platter (a choice of 3: Pastrami, Corn Beef, Smoked Turkey, Bologna, Salami) Potato Salad or Coleslaw Kugel (Potato, Sweet Noodle, Butternut Squash/Pumpkin Pie, Pumpkin Muffins) Pasta Salad (Sesame Noodles, Tomato Basil Pasta, Sweet Vinegar) Vegetarian Cholent with Kishka 2 Dips (Babaganoush, Olive, Red Pepper, Chummus/Techina, Dill) Pickles, Olives, Onion, Tomato Fruit Cake OR Babka Kugel Please make your selection from the drop down menu Please Select Potato Sweet Noodle Butternut Squash/Pumpkin Pie Pasta Salad Please make your selection from the drop down menu Please Select Sesame Noodles Tomato Basil Pasta Sweet Vinegar Potato Salad or Coleslaw Please make your selection from the drop down menu Please Select Potato Salad Coleslaw Deli Platter (choice of 3) Please Select Pastrami Corn Beef Smoked Turkey Bologna Salami Deli Platter 1 Please Select Pastrami Corn Beef Smoked Turkey Bologna Salami Deli Platter 2 Please Select Pastrami Corn Beef Smoked Turkey Bologna Salami Deli Platter 3 2 Dips Please make your selection from the drop down menu Please Select Babaganoush Olive Red Pepper Chummus/Techina Dill Cake OR Babka Please make your selection from the drop down menu Please Select Cake Babka For the week of* Please choose the week you would like to sponsor your Kiddush Month Day Year In Honor/memory of Total $0.00 Payment Credit Card Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Expiration Year Please mail checks payable to Chabad Jewish Center, 23665 Moulton Pkwy, #D, Laguna Hills, CA 92653 Notes I would like to receive news and updates by email Submit Clear Form Should be Empty: This page uses TLS encryption to keep your data secure.
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