Passaic Neighborhood Center

for Women

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An Afternoon with Pam Jenoff

- Events
  - Author Luncheon
    
    Author Luncheon Payments
    Author Luncheon PayPal
  - Sponsorships

Please use the form below to Register/RSVP for the Author Luncheon. Please note that this is for PayPal or Check payments only.
You will receive the book "Code Name Sapphire" with each ticket purchase.
Register/RSVP and Pay with PayPal or Check
The maximum number of form submissions has been reached. This form is currently not available.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Please list the names of the people who will be joining you at the luncheon:
- Amount of Tickets:
  $130 - 1 Ticket
  $260 - 2 Tickets
  $390 - 3 Tickets
  $520 - 4 Tickets
  $650 - 5 Tickets
  $780 - 6 Tickets
  $910 - 7 Tickets
  $1,040 - 8 Tickets
  $1,170 - 9 Tickets
  $1,300 - 10 Tickets
- Please select how many tickets you are purchasing
- I am not able to attend but I would like to make a donation Please enter valid data.
- A raffle for valuable prizes will be held as well!
- I authorized to make the payment via PayPal or Check Please select this field.
- To pay online via PayPal or check, please click "Submit" and follow the instructions.
Submit

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