Couvert: $600 per Couple • Ad Journal Deadline: Thursday, December 4, 2014

Reservations & Seating
I/we would like to reserve   seats at the Dinner at $600 per couple   I/we prefer to be seated with


Names of persons attending
Please reserve   seats at the Dinner complimentary with my journal ad  
I/we are unable to attend but wish to celebrate this milestone with a donation of $  

Dinner Tribute Journal
We invite you to place an ad in our 2014 Celebration Journal as a way to support the activities of Chabad of the Five Towns. You may consider either a business advertisement; or messages honoring the Honorees, Committee Members; or in memory of a loved one.

Advertising contributions are tax deductable to the maximum permitted by law.
I/WE WISH TO HAVE MY ADVERTISEMENT OR MESSAGE APPEAR ON THE FOLLOWING TYPE OF PAGE:
Double Chai Builder | $36,000 Chai Page | $1,800
Grand Master Builder | $25,000 Gold Page | $1,000
Master Chai Builder | $18,000 Silver Page | $770
Master Crown Builder | $10,000
Full Page | $600
Includes dinner reservations for two
Crown Page | $5,000
Half Page | $360
Diamond Page | $3,600 Quarter Page | $250
Platinum Page | $3,000
Includes dinner reservations for a table of ten		 Business Card Listing | $125

 

My/Our ad is in honor of:
Mr. & Mrs. Shlomo & Addi Kapetas
  Dr. & Mrs. Leonard & Phyllis Lubin
  Mr. & Mrs. Yosef Y. & Penina B. Popack
  Mr. & Mrs. Shmuel & Estee Salman		 Mr. & Mrs. Shlomo & Ahuvas Slatus
Dinner Chairmen
Chabad of the Five Towns
Other
**To send artwork, email [email protected]

Payment
Card Information
If you wish to pay with a check, please fill out this form, print and mail it together with a check to:
Checks should be made payable to Chabad of the Five Towns and mailed to 74 Maple Avenue Cedarhurst, NY 11516
Total Amount
Credit Card Type
Card Number
Exp. Date
  		Cvv Code
 
Contact Information
First Name
Last Name
Address
City / State / Zip
    		Phone
Email