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Order Shabbat-To-Go

Need to stay over at the hospital for Shabbat? We bring Shabbat to you! Our Shabbat in a Box includes 3 Course dinner with Challah, Kiddush cup and grape juice, hospital-friendly Shabbat candles (LED), Chocolate Box, and more.
1. Your Infomation
Full Name*
First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number
Hospital*
Floor & Room Number*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Any Comments / special requirements
2. Suggested Donation
Amount

$18$36$54$180$360$500$770$1800
Other amount

$
Total

$0.00
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Credit Card Cheque, E-Transfer, Other.

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