Catered Kosher Meals

Application for the Catered Meals option of the Kosher Senior Night Program

Before you fill out form, please keep in mind the following:

- Kosher Senior Night is the last Monday of every Month.

- These catered meals can either be picked up or delivered. Pickup is at 16820 NE 6 ^th Court in North Miami Beach. If you choose delivery, we will G-d willing, arrange a volunteer to deliver. They will call you a day or two beforehand and give you an approximate time. *If you did not receive any call or email by noon of the day before Kosher Senior Night, please call Rabbi Smith at (954) 458-6000.

- There could be situations where the Catered Meals will be available on a different day in proximity to Kosher Senior Night but not exactly on that day. We will send an email and/or phone call if this occurs.

- All participants in Kosher Senior Night, whether the discounts at restaurants or the Catered Meals option, are eligible for our bi-monthly raffles.

Full Name*

First Name Last Name

E-mail

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Information that someone delivering to you should know: (only if applicable)

Pick up or get it delivered?*

I plan to pick up my meal at 16820 NE 6th Court in North Miami Beach I plan to pick up my meal and I volunteer to deliver a meal to a few people who live near me I need my meal to be delivered to my address I would rather if smoeone can deliver, but if not, I can pick up

Pay or get it fully sponsored?*

I am happy to pay the nominal fee of $10 for the Catered Kosher Meal For various reasons, I can only accept this meal if fully sponsored I would like to be a sponsor for this program (We will contact you)

I would also like to order a few extra meals (for the same nominal fee)

Yes No Option 3

If yes, how many meals do you need in total? *Pease note that it is the same meal being served

Kosher Senior Night is a project of United Jewish Generations

Conversational Yiddish

Torah and Tea

Cafe Chai

Holiday Celebrations

Shabbat Dinner

Levi Yitzchok Retiree Academy