Full Name*First NameLast NameAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryPhone Number*Area CodePhone NumberE-mail*Kiddush OptionsPlease choose one of the three options below, and choose your selections from the drop down menus of that option.Option 1Dairy/Parave Kiddush$180Bagels LoxCream CheesePickles, Olives, Onion, TomatoVegetarian Cholent with KishkaKugel (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 SaladPlease make your selection from the drop down menuPlease SelectPotato - KugelSweet Noodle - KugelButternut Squash/Pumpkin Pie - KugelSesame Noodles - Pasta SaladTomato Basil Pasta - Pasta SaladSweet Vinegar - Pasta SaladDipPlease make your selection from the drop down menuPlease SelectBabaganoushOliveRed PepperChummus/TechinaDillFruit OR Cake OR BabkaPlease make your selection from the drop down menuPlease SelectFruitCakeBabkaOption 2Dairy/Parave Kiddush$180Challah Rolls OR BagelsGefilte Fish OR White Fish Salad Tuna SaladEgg SaladPickles, Olives, Onion, TomatoVegetarian 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 BagelsPlease make your selection from the drop down menuPlease SelectChallah RollsBagelsGefilte Fish OR White Fish SaladPlease make your selection from the drop down menuPlease SelectGefilte FishWhite Fish SaladKugel OR Pasta SaladPlease make your selection from the drop down menuPlease SelectPotato - KugelSweet Noodle - KugelButternut Squash/Pumpkin Pie - KugelSesame Noodles - Pasta SaladTomato Basil Pasta - Pasta SaladSweet Vinegar - Pasta SaladDipPlease make your selection from the drop down menuPlease SelectBabaganoushOliveRed PepperChummus/TechinaDillFruit OR Cake OR BabkaPlease make your selection from the drop down menuPlease SelectFruitCakeBabkaOption 3Deli Kiddush$360Challah RollsDeli Platter (a choice of 3: Pastrami, Corn Beef, Smoked Turkey, Bologna, Salami)Potato Salad or ColeslawKugel (Potato, Sweet Noodle, Butternut Squash/Pumpkin Pie, Pumpkin Muffins)Pasta Salad (Sesame Noodles, Tomato Basil Pasta, Sweet Vinegar) Vegetarian Cholent with Kishka2 Dips (Babaganoush, Olive, Red Pepper, Chummus/Techina, Dill) Pickles, Olives, Onion, TomatoFruit Cake OR Babka KugelPlease make your selection from the drop down menuPlease SelectPotatoSweet NoodleButternut Squash/Pumpkin PiePasta SaladPlease make your selection from the drop down menuPlease SelectSesame NoodlesTomato Basil PastaSweet VinegarPotato Salad or ColeslawPlease make your selection from the drop down menuPlease SelectPotato SaladColeslawDeli Platter (choice of 3)Please SelectPastramiCorn BeefSmoked TurkeyBolognaSalamiDeli Platter 1Please SelectPastramiCorn BeefSmoked TurkeyBolognaSalamiDeli Platter 2Please SelectPastramiCorn BeefSmoked TurkeyBolognaSalamiDeli Platter 32 DipsPlease make your selection from the drop down menuPlease SelectBabaganoushOliveRed PepperChummus/TechinaDillCake OR BabkaPlease make your selection from the drop down menuPlease SelectCakeBabkaFor the week of*Please choose the week you would like to sponsor your KiddushMonthDayYear In Honor/memory ofTotal$0.00PaymentCredit Card Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity Code1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2020202120222023202420252026202720282029Expiration YearPlease mail checks payable to Chabad Jewish Center, 23665 Moulton Pkwy, #D, Laguna Hills, CA 92653NotesI would like to receive news and updates by emailSubmit Clear FormShould be Empty: This page uses TLS encryption to keep your data secure.
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