Prime Timers Dinner and a Movie
March 23 | 5:30 pm
Join us for dinner and a movie! Yoo-hoo, Mrs. Goldberg!
____________________________________________________
Thank you for your interest in
Prime Timers Dinner and a Movie
. This form is currently closed. Please reach out to Susan Karon at skaron@tbewellesley.org with any questions.
TBE Form Password:
Event Waitlist
Yes, I would like to register for the waitlist for this event
REGISTRATION
Are you a TBE Member?
Yes
No
What is your connection to TBE?
Number of adults attending:
Please select...
1
2
3
4
Number of adult members attending:
Please select...
1
2
3
4
Number of adult non-members attending:
Please select...
1
2
3
4
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
SHABBAT & PROGRAM REGISTRATION
Please select your preferred option for the in-person activities:
Dinner & Program (In-Person)
Program (In-Person
DINNER & PROGRAM REGISTRATION
Are you a TBE Member?
Yes
No
What is your connection to TBE?
Dinner & Program Registration - Number of adults attending:
Please select...
1
2
3
4
Dinner & Program - Number of adult members attending:
Please select...
1
2
3
4
Dinner & Program - Number of adult non-members attending:
Please select...
1
2
3
4
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
PROGRAM REGISTRATION
Are you a TBE Member?
Yes
No
What is your connection to TBE?
Program Registration - Number of adults attending:
Please select...
1
2
3
4
Program Registration - Number of adult members attending:
Please select...
1
2
3
4
Program Registration - Number of adult non-members attending:
Please select...
1
2
3
4
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
First Name
Last Name
Mobile Phone
Primary Email
CUSTOM QUESTIONS
Are you age 65 or older?
Yes
How will you be attending?
In Person
Online
Will you be taking the bus?
Yes
I would be interested in carpooling with TBE
Yes
TOT SHABBAT DATES
We would like to register for the following dinners:
You can always come back to this form and register for additional dinners in the future!
Month X1, 202X: 5:30pm
Month X2, 202X: 5:30pm
Month X3, 202X: 5:30pm
Month X4, 202X: 5:30pm
Month X5, 202X: 5:30pm
Month X6, 202X: 5:30pm
Month X7, 202X: 5:30pm
Month X8, 202X: 5:30pm
NUMBER OF YOUTH ATTENDING
Number of youth attending:
Please select...
1
2
3
4
5
6
7
8
9
Number of youth non-members attending:
Please select...
1
2
3
4
5
6
7
8
9
First Name (#1)
Last Name (#1)
DOB (#1)
Grade (#1)
Age (#1)
First Name (#2)
Last Name (#2)
DOB(#2)
Grade (#2)
Age (#2)
First Name (#3)
Last Name (#3)
DOB (#3)
Grade (#3)
Age (#3)
First Name (#4)
Last Name (#4)
DOB (#4)
Grade (#4)
Age (#4)
First Name (#5)
Last Name (#5)
DOB (#5)
Grade (#5)
Age (#5)
First Name (#6)
Last Name (#6)
DOB(#6)
Grade (#6)
Age (#6)
First Name (#7)
Last Name (#7)
DOB (#7)
Grade (#7)
Age (#7)
First Name (#8)
Last Name (#8)
DOB (#8)
Grade (#8)
Age (#8)
First Name (#9)
Last Name (#9)
DOB (#9)
Grade (#9)
Age (#9)
SESSION CHOICES
Members
Fall
Winter
Spring I
Spring II
Non Members
Fall
Winter
Spring I
Spring II
PHOTO & VIDEO PERMISSIONS
I grant my permission to use any and all written comments, pictures, or video in which my child or I may appear for print, audio, visual, and/or electronic publicity promotion and advertising on behalf of TBE and its programs.
Yes
No
DIETARY RESTRICTIONS & FOOD ALLERGIES
Please list any dietary restrictions and/or food allergies:
GENERAL & MEDICATION ALLERGIES
Please list any general allergies and/or allergies to medications:
MEDICAL CONDITIONS
Please list any medical conditions:
EMERGENCY CONTACT INFORMATION
Emergency Contact #1
Full Name
Mobile Phone
Primary Email
Relationship
Emergency Contact #2
Full Name
Mobile Phone
Primary Email
Relationship
DONATIONS
Please consider making a donation
REGISTRANT INFORMATION
for confirmation email
First Name*
Last Name*
Mobile Phone*
Primary Email*
Credit Card No.
Exp. Month
MM
x
Exp. Year
YYYY
x
Verification Code
_____________________ADDRESS LOCATOR INSTRUCTIONS____________________________
Please type out your full address below (including a comma after the street name) until it appears as an option in the dropdown box.
For any unit or apartment number, enter the number only in the designated box.
For all PO Box addresses, type the address of the post office in the address section below. Then type "PO Box #XXX" in the "Unit/Apt/PO Box" field.
Billing Street:
Unit/Apt/PO Box #
Billing City
Billing State
Billing Zip Code
Is your mailing address the same as your billing address?
Yes
No
Mailing Street:
Unit/Apt/PO BOX #
Mailing City
Mailing State
Mailing Zip Code
Total
$
Total Registrants
Dinner & Program Registrants
Program Registrants
Adult Registrants
Youth Registrants
Member Registrants
Non-Member Registrants
Today's Date
General Hidden Fields
Outreach ID
Designation ID
Dinner Price
Member Price
NonMember Price
Price
Gateway Amount
$
Gateway Quantity
ContactID
AccountID
REGISTRATION - CAPACITY
Form - Registration - Current Tally
Prefill - SF - Registration - Currently Tally
DINNER & PROGRAM - CAPACITY
Form - D&P - Current Tally
Prefill - SF - D&P - Currently Tally
PROGRAM - CAPACITY
Form - Program - Current Tally
Prefill - SF - Program - Currently Tally
ADULT - CAPACITY
Form - Adult - Current Tally
Prefill - SF - Adult - Currently Tally
YOUTH - CAPACITY
Form - Youth - Current Tally
Prefill - SF - Youth - Currently Tally
Finance - Registrations $ Total
Form - Finance $ - Current Tally
Prefill - SF - Finance $ - Current Tally
HIDDEN FIELDS - FORM REQUESTS
FORM #1
: ARE YOU A TBE MEMBER?
Yes
FORM #2
: # OF ADULTS ATTENDING?
Yes
FORM #3
: # OF ADULT MEMBERS ATTENDING?
Yes
FORM #4
: # OF ADULT NON-MEMBERS ATTENDING?
Yes
FORM #5
: ARE YOU 65 OR OVER?
Yes
FORM #6
: HOW WILL YOU BE ATTENDING?
Yes
FORM #7
: WILL YOU BE TAKING THE BUS?
Yes
FORM #8
: I WOULD BE INTERESTED IN CARPOOLING
Yes
FORM #9
: TOT SHABBAT DINNERS
Yes
FORM #10
: # OF YOUTH ATTENDING?
Yes
FORM #11
: # OF YOUTH MEMBERS ATTENDING?
Yes
FORM #12
: # OF YOUTH NON-MEMBERS ATTENDING?
Yes
FORM #13
: SESSION SEASONAL BOXES FOR MEMBERS & NON-MEMBERS?
Yes
FORM #14
: PHOTO & VIDEO PERMISSIONS?
Yes
FORM #15
: DIETARY RESTRICTIONS & FOOD ALLERGIES
Yes
FORM #16
: MEDICAL CONDITIONS
Yes
FORM #17
: GENERAL/MEDICATION ALLERGIES
Yes
FORM #18
: SUGGESTED DONATION
Yes
FORM #19
: EMERGENCY CONTACT (NAME, PHONE NUMBER, EMAIL, RELATIONSHIP
Yes
FORM #20
: SHABBAT DINNER & PROGRAMS
Yes
FORM #21
: Registration
Yes
FORM #22
: TBE FORM WAITLIST FIELD
On
FORM #22
: BILLING ADDRESS
On
FORM #22
: MAILING ADDRESS
On
HIDDEN FIELDS - AUTHORIZE
AUTHORIZE_DOT_NET_TRANSACTION_ID
AUTHORIZE_DOT_NET_TRANSACTION_ID
AUTHORIZE_DOT_NET_STATUS
AUTHORIZE_DOT_NET_CREDIT_CARD_SUFFIX
AUTHORIZE_DOT_NET_SUBSCRIPTION_ID
AUTHORIZE_DOT_NET_AUTH_TOKEN
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