Extreme Teen Night

Saturday, November 8, 2025 • 17 Cheshvan 5786

8:00 PM

USE FORM BELOW TO RESERVE OR SPONSOR

Register

PLEASE NOTE: There is different pricing for MEMBERS and NON-MEMBERS. Please select the correct pricing tier for each participant.

PARENT CONTACT INFORMATION
This will also serve as emergency contact information.

* First Name

* Last Name

* Phone

* Email

* Address

* City

* Zip Code

* Relationship to participants

* Which Synagogue are you associated with?

PARTICIPANT INFORMATION

PLEASE LIST EACH PARTICIPANT INDIVIDUALLY
- CLICK THE PLUS ICON BELOW FOR EACH NAME YOU ARE ADDING.

NOTE- Be sure to select the correct pricing tier for each participant based on membership status.

* First Name

* Last Name

* Grade

School

* Phone

* Email

* Select Category

EVENT SPONSORSHIP

SELECT A SPONSORSHIP LEVEL (optional)

If you would be interested in subsidizing this event, please select your sponsorship level. Thank you in advance as your partnership makes our programs possible.

Total Due

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Sat, November 8 2025 17 Cheshvan 5786

West Side Institutional Synagogue • 120 West 76th Street • New York, NY 10023
Tel: 212-877-7652 • Fax: 212-877-9333 • Email: office@wsisny.org

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