DINNER RESERVATIONS

Please List First and Last Name(s) of all Attendees:

SPONSORSHIP & TRIBUTE JOURNAL OPPORTUNITIES

$25,000 FOUNDING BENEFACTOR • Special mention as underwriter at the banquet • Tickets for up to 30 guests • Premier Founding Benefactor Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala • Mekor Habracha Plaque on Wall of Donors

$18,000 CHAI DIAMOND BENEFACTOR • Tickets for up to 20 Guests • Premier Chai Diamond Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala • Mekor Habracha Plaque on Wall of Donors

$10,000 DIAMOND BENEFACTOR • Tickets for up to 12 Guests • Premier Diamond Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala • Mekor Habracha Plaque on Wall of Donors

$5,000 PLATINUM BENEFACTOR • Tickets for up to 10 Guests • Platinum Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala

$3,600 GOLD BENEFACTOR • 8 Gala Tickets • Gold Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala

$1,800 SILVER BENEFACTOR • 4 Gala Tickets • Silver Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala

$1,200 BRONZE BENEFACTOR • 2 Gala Tickets • Bronze Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala

$1,000 BRONZE BENEFACTOR • Bronze Full Page Tribute Journal Ad • Donor Listing on the Screen Display at the Gala

$700 FRIEND • 2 Gala Tickets • 1/2 Page Tribute Journal Ad

$500 FRIEND • 1/2 Page Tribute Journal Ad

$300 TRIBUTE JOURNAL • 1/4 Page Tribute Journal Ad

$150 TRIBUTE JOURNAL • 1/8 Page Tribute Journal Ad

$50 TRIBUTE JOURNAL • Greeting Ad

Other........................... Other...........................

This donation is being made in honor of (check all that apply)

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PAYMENT

Title

First Name *

Last Name *

Street Address *

Address Line 2

City *

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Zip Code *

Home Phone

Cell Phone *

Email Address *

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Thank you for your support!

Please insert the sum of your donation in the box below:

Total Amount *

Rebecca Somach & Shaul Kushinsky	Miriam & David Morley	Rabbi Eliezer Hirsch & Miriam Ort	Mekor Habracha
Other Other