Reservations

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Your Name*

First Name Last Name
E-mail*
Gala Dinner
How Many Seats ?* For Scroll of Honor or a simple donation please select "I will not be able to join" and see below
Names of persons attending:
Scroll of Honor
Choose a Level on the Scroll of Honor If you want to level up please fill in the Other Donation option below to make the correct total for the Level.

Basic Level $1000 (includes 1 seat at dinner) Bronze Level $1,250 (includes 2 seats at dinner) Silver Level $1,800 (Includes 3 seats at dinner) Gold Level $2,600 (Includes 4 seats at dinner) Platinum Level $3,600 (Includes 5 seats at dinner) Diamond Level $5,400 (Includes 1 table of 12 at dinner) Event Sponsor $25,000 (Acknowledged as an Event Sponsor)
My/Our donation is in honor of:

Mr & Mrs Ted Ballison Hon. Donald X Clavin Jr ~ Community Leadership Award Eliana & Avi Rave Jacob Scheiner ~ Young Leadership Award Rozana Zemlyansky ~ Woman of Valor Rabbi & Rivkie Tenenboim
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Donations
Please use this opportunity to support the Chabad House and purchase raffle tickets for the Grand Raffle or by making a donation
Other Donation

$
Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card I will send a Check

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If you have any questions about the registration form, the Scroll of Honor or you would rather RSVP over the phone please call Sharon at 516-350-0720.
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Gala Dinner