Chai-Athlon

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Check the Event(s) you want to participate in:*

Registration Package

Single ($18)
Couple or Family ($36)
Family Sponsor ($180)

Registration fee includes: Entry, event, 2 t-shirts per family registration, snacks & beverages!

Family sponsor includes the registration package plus 2 additional T-shirts and your family name printed on the T-shirt.

Shirt 1 Size*

Shirt 2 Size*

Shirt 3 Size*

Shirt 4 Size*

Print Your Name As*

How would you like to pay?*

Pay Online Now
I will send a check

Total (including 3.5% online processing fee)

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please make checks payable to:
Dix Hills Jewish Center

Please mail checks to:
Dix Hills Jewish Center
555 Vanderbilt Pkwy
Dix Hills, NY 11746

Online Registration