High Holiday Pass Order Form

August 31, 2022 September 28, 2022

Beth Shalom

In order to request a High Holiday Pass for in-person participation, everyone in your immediate family and family guests must be vaccinated, except for children ages 0 to 4. If you have any questions, please contact Robert Gleiberman at rgleiberman@bethshalompgh.org or 412-421-2288 x226.

By submitting the form below, I attest that each individual in my immediate family or family guest, for whom I am ordering a pass, has been vaccinated or are ages 0 to 4. I also agree to enforce all safety protocols for myself and, if applicable, for everyone for whom I am ordering passes. Additionally, I agree to instruct my children, ages 6 and up, to either be engaged in youth programming or be in the main adult service. I understand that NO CHILDREN are to be wandering the building without parental supervision.

HIGH HOLIDAY PASS CHARGES

Members in good standing - No charge
Guests of members in good standing - $100 per adult
Non-members - $250 per adult
Children under 18 years of age - No charge

High Holiday Ticket Order Form 2022/5783

Person Ordering Passes Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Email *

Enter the first and last name, including yours, of each person for whom you are requesting a pass. Member's Guest passes are $100 each. Non-member passes are $250 each.

Member or Non-Member Adult 1 Name *

Member or Non-Member Adult 2 Name (Enter NA if not applicable) *

Member or Non-Member Adult 3 Name (Enter NA if not applicable) *

Member or Non-Member Adult 4 Name (Enter NA if not applicable) *

Child 1 Name (Enter NA if not applicable) *

Child 2 Name (Enter NA if not applicable) *

Child 3 Name (Enter NA if not applicable) *

Child 4 Name (Enter NA if not applicable) *

Member's Guest 1 Name (Enter NA if not applicable) *

Member's Guest 2 Name (Enter NA if not applicable) *

Member's Guest 3 Name (Enter NA if not applicable) *

Member's Guest 4 Name (Enter NA if not applicable) *

Guest of Member Passes (Guest of member passes are $100 each.)

$100.00 (1 guest ticket)
$200.00 (2 guest tickets)
$300.00 (3 guest tickets)
$400.00 (4 guest tickets)

Non-member Passes (Non-member passes are $250 each.)

$250.00 (1 non-member pass)
$500.00 (2 non-member passes)
$750.00 (3 non-member passes)
$1,000.00 (4 non-member passes)

Total number of passes ordering *

Total Amount

$0.00

Categories: Holidays

High Holiday Pass Order Form

Enter the first and last name, including yours, of each person for whom you are requesting a pass. Member's Guest passes are $100 each. Non-member passes are $250 each.

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