[1]  PERSONAL INFO

[2]  RESERVATIONS

  Last Name

Please select one of the following
 RSVP & Journal Ad (see section 3)
 Reservation Only (Couvert $180 per person)
 Journal Ad Only

How many will be attending?

In honor of
 Elliot & Renee Birnbaum
 Andrew & Elisa Haber
  Vincent Trimarco Jr.
 Chabad of Mid Suffolk
 Other

  First Name
 Address
  City
  State
  Zip
  Phone
  E-mail
Seat me with

   
 
 

[3]  AD JOURNAL OPPORTUNITIES
We invite you to place an ad in our Benefit Evening Journal as a way to support the Chabad of Mid Suffolk. You may consider either a business advertisement; or messages honoring any or all of our honorees; honoring Chabad; honoring anyone or in memory of a loved one.
I wish to have my advertisement or message appear on the following type of page:
 Event Sponsor: $10,800
          Includes table for 10 and mentioned as the Event Sponsor,
         Inside front cover and outside back cover of Journal are
         reserved for the Event Sponsor only. There is one Event  
         Sponsor available.
 Diamond Sponsor Page: $5,400   
         Includes table for 10 and mention as a Diamond Sponsor on 
         the event signage.
 Platinum Sponsor Page: $3,600 
         Includes dinner for 6 and mention as a Platinum Sponsor on 
         the event signage
 Gold Page: $1,800  
         Includes dinner for 4		  Silver Page: $1,200  
         Includes dinner for 2
 Full Page: $600

 Half Page: $360

 1/4th Page: $180 

 One Line: $36  
       One line mention in Journal Book, 8 words max.
 

 

[4]  PAYMENT
  I will mail a Check      Please charge my card below
Total Amount

Comments (optional)

Card Type
Card Number
Expiration         
Cvv Code

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