Contact Information
First Name
Last Name
Address
City / State / Zip
   
Phone
Email

Ticket Purchase
The Jean Fischman Chabad Center of the Five Towns
Gala Raffle to be drawn at the Annual Dinner
Sunday, December 14, 2014,  Kislev 22 at 6:00 PM
The Grand Ballroom of the Sands
1395 Beech Street, Atlantic Beach, New York
Split the Pot - Be a Winner with Chabad!

Split the raffle winnings from “Split the pot”
Split the Pot tickets are $10 each
How many? 
1st Prize: Trip to Israel

Two Round Trip Tickets to reconnect with your roots
Restrictions Apply
Donated by Flywithclass.com
How many? 
2nd Prize: Decked in Diamonds

Two-Toned Diamond Dial Watch: 18K Yellow Gold;
109 Diamonds total WC 0.64ct
Valued at $2,345   
Donated by The Jeweler’s Wife
How many? 
3rd Prize: Get Hi-Tech

MacBook Air 13 inch: 128GB 1.4G Hz dual-core Intel core i5 processor; Turbo Boost up to 2.7 GHz; intel HD Graphics 5000; 4GB memory; 128GB; PCle-based flash storage
Valued at $999               
Donated by Mr. & Mrs. Jeremy Kahn 
How many? 

         

4th Prize: Vacation on the Island

Two night’s stay for two lucky people at the New Allegria Hotel, a stunning oceanfront hotel located in Long Beach, NY and a dinner for two at Prime Bistro 
Valued at $799
Donated by Allegria Hotel and Prime Bistro
How many? 
5th Prize: Enhance your Shabbat Table

Beautiful bouquet of flowers for Shabbat delivered to you every week for one year. (delivery to the 5 Towns & Far Rockaway area only)
Donated by Mr. & Mrs. Gidon & Alla Shema of Jerusalem Florist
How many? 
6th Prize: Vacation in the City

A relaxing night out for two at the SOHO Grand Hotel and a Gift Certificate for Dinner at Reserve Cut
Valued at $650      
Donated by Mr. & Mrs. Jeremy Kahn
How many? 
Tickets: $25 each or 5 for $100. How many tickets are you purchasing in total?
Sold by: 

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
 

For more information please call: (516) 295-2478