JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Join us! We are now taking reservations for our Dinner in the Sukkah on Sunday, October 13. (Please make your reservation by Wed, October 9th)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name:
*
Your answer
Email or Phone Number:
*
Your answer
Number of adults attending (12 years and older): ($10 each)
Your answer
Number of children attending: (there is no charge but we do need a reservation)
Your answer
Names of adults and children attending:
Your answer
Are you a first-year member of Heska Amuna? If so, enjoy your first Shabbat dinner with us at no cost.
Yes, I am a first-year member; thank you for covering our dinner fee!
No, I am not a first-year member
Clear selection
TOTAL DUE:
*
Your answer
Payment Options
*
I will pay by check (send check to Heska Amuna Synagogue, 3811 Kingston Pike, 37919)
Please put the charge on my credit card that you have on file for me; I acknowledge that 3% will be added to my bill to cover the costs assessed by the credit card company
I will call the office (522-0701) or come by to take care of making payment
Any comments or suggestions you would like to share with us? (Thanks!)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Heskaamuna.org.
Report Abuse
Forms
