JWC 5784

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Full Name*
First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number
How many women in your group?(this will automatically calculate your charge. Do not write it in again)*
We rely on Sponsorship for all events, please consider helping us cover the cost of this event.
$180/sponsor

$180
Everyone is welcome to join the JWC events. If you are not able to pay, please contact Rivkie Barash (954) 549 3315
I'd like to sponsor someones entrance fee

$36

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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