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This year's Gala will be held at our Chabad House
11520 Darnestown Road, Gaithersburg
 

 

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  Your Information
Name
Address
City, State
Zip
Daytime Phone
Email

 

Attendance

Please make  adult reservations @ $180 each 
Please provide the names of attendees:

 

Sponsorships & Journal Information

Chai Sponsor (includes 2 VIP tables of 10)........... $18,000  
Diamond Sponsor (includes 2 VIP tables of 10)..... $10,000  
Gold Sponsor (includes 1 VIP table of 10)............. $5,000  
Silver (includes VIP table of 10)............................ $3,600  
Chai (includes 4 dinner tickets).............................$1,800 
Sponsor Page (includes 2 dinner tickets) .............. $1,000 
Half Page ............................................................$360 
Greeting ..............................................................$125 
Listing .................................................................$54


If you are placing an ad or greeting in the Journal, please use this box to indicate what size and to provide the text:

 

  Payment Information
Method of Payment use credit card on file
credit card 
 PayPal
will send check
paypal.jpg If you choose the Paypal option, after submitting payment, be sure to come back and click "Submit" on this form.

Credit Card #

Exp. Date (MM/YY)
Security Code
Grand Total 
amount of payment