Name *

First Name

Last Name

Phone *

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Please check the mivtzoim option you'd prefer.

Senior/Nursing Home

Visit 10 homes

Visit 15 homes

Visit 20 homes

I already have people to visit

Other - specify in "comments"

On which day do you plan on making your visits?

If you can't go on Purim itself, you can go during the week before. Packages will be available starting Sunday 3/17

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