Young Leadership Council Summer Night Out 1Registration2Payment Registration InfoName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Select Attendee Package (Limited Flash Sale Price!)(Required)The estimated market value of this event is $50 per person. I would like to join the Giving Circle $90 per Person $180 a Couple I am a Giving Circle member (Reservation Only) Limited Flash Sale Price! $250 $180 per couple $125 $90 per personSelect Attendee Package(Required)\VIP includes reserved seating at a front-row table, reserved parking, and a gift bag I would like to join the Giving Circle $90 per Person $180 a Couple $360 VIP Ticket I am a Giving Circle member (Reservation Only) Project Ezrah has started an initiative called the “YLC Giving Circle”. For $85 a month you can make a major impact on your community. Join this exclusive group of young leaders in our community today! With a three year pledge to be part of the giving circle you receive two tickets to both the YLC Summer Night Out Event and the Project Ezrah Annual Dinner in December. In addition you will be invited to exclusive events and be part of the safety net that holds up Bergen County.Giving Circle MembershipGiving Circle Payment Options(Required) $85 per month $500 biannually $1,000 annually Giving Circle VIP UpgradeGiving Circle Upgrade to VIP Upgrade to VIP for only This field is hidden when viewing the formTodays Date MM slash DD slash YYYY Attendee PriceAttendee Name(Required) Add RemoveSingle Attendee QuantityAttendee Names(Required)Name OneName Two Add RemoveCouple Attendee QuantityTotal AttendeesHow did you hear about the event?(Required) Jewish Link Jewish Standard Email from Project Ezrah Friends and Family Social Media Post Other Attendee Subtotal Price: $0.00 Registration Subtotal $0.00 This field is hidden when viewing the formCoupon CodeDiscount $0.00 Would you like to make a voluntary additional donation?(Required) Yes No Thank you for being part of our exclusive group of young leaders in our community today! Your tickets to both the YLC Summer Night Out Event and the Project Ezrah Annual Dinner in December are included in your membership. Click submit to finish registration.Additional Donation - Fully DeductibleDonation Amount Tribute Type None In Memory Of In Honor Of Tribute NameTribute Special NotePaymentTransaction Fee AmountTransaction Fees Help cover our transaction fees ($) so that 100% of your registration fee and donation goes to those in need. Transaction Fee Product Price: $0.00 Total The next payment for your circle membership will be for $85 in 30 days.The next payment for your circle membership will be for $500 in 180 days.The next payment for your circle membership will be for $1,000 in 360 days.Credit CardCard Details Cardholder Name This field is hidden when viewing the formWould you like to be a member of the Giving Circle?Project Ezrah has started an initiative called the “YLC Giving Circle”. For $85 a month you can make a major impact on your community. Join this exclusive group of young leaders in our community today! With a three year pledge to be part of the giving circle you receive two tickets to both the YLC Summer Night Out Event and the Project Ezrah Annual Dinner in December. In addition you will be invited to exclusive events and be part of the safety net that holds up Bergen County. Yes, I would like to join the giving circle! Please be in touch with me with further information. No Δ