Bnei Akiva EventsName* First Last Phone*Email* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Choose your event*Choose your eventLag Ba'omerTilboshetShirt Size*SMPlease fill out this Safety Waiver Please indicate any dietry restrictions you may have.Will you be needing a walking group?* Yes No If you aren't interested in signing up for the BAYT Latke Night on Motzei Shabbat, use promo code "NOLATKE" in the coupon field below. I have filled out the safety waiver* Yes NoQuantityTotal $ 0.00 CAD How would you like to pay?* Credit Card CashCredit Card*MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Coupon
