Paint and Sip I will be attending this event Non JWC Member $45 JWC Member $40. Yes I would like to be a JWC member $36 Title* First Name* Last Name* Address Line 1* Address Line 2 City* State Zip Code* Country* Phone This is my home business address. Card Type* Discover AMX Master Visa Amount to Charge* Card Number* Expiration Date* 1 2 3 4 5 6 7 8 9 10 10 11 12 2019 2020 2021 2022 2023 2024 2025 CVV Security Code What's This? Acknowledgement Email Address* Reconfirm Email Address* Payment by Check: If you would like to submit a check, please print out this page and send the completed form along with your payment/donation to: Chabad of Bradenton 5712 Lorraine Road Bradenton, FL 34211 Please click submit only once. Please wait a few seconds for acknowledgement online that your information was received. We will send you a receipt once your donation has been processed. If you have problems with this form please notify us by clicking here. Notes/Comments This page uses 128 bit SSL encryption to keep your data secure.