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RESERVE A SIMCHA

FIRST NAME *

LAST NAME *

ADDRESS *

CITY *

STATE *

ZIP CODE *

PHONE *

CELL PHONE  

EMAIL ADDRESS *

TYPE OF EVENT 

NUMBER OF GUESTS EXPECTED 

DATE OF EVENT  

ALTERNATE DATE(S)  

LOCATION OF EVENT  

ALTERNATE LOCATION  

COMMENTS 

* Required fields

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YOSSIE WEINTRAUB, proprietor

973-699-3431

yossieweintraub@aol.com

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