Reservations / Birthday Wishes

Your Name*
First Name Last Name
E-mail*
Gala Dinner
How Many Seats?* *If you are paying for the seats together with your Book of Birthday Wishes donation please make that selection from the drop down menu and indicate the level below in the Book of Birthday Wishes section. **If you are unable to attend please make that selection from the drop down menu and then choose a level on the Book of Birthday Wishes or fill in your donation below.
Names of persons attending:
Book of Birthday Wishes
Choose a 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)Ruby Level $5,400 (Includes 1 table of 12 at dinner)Diamond Level $10,000 (includes 1 table of 12 at dinner)Event Sponsor $25,000 (Acknowledged as an Event Sponsor)
Birthday Wishes, Notes or Comments for us?
My/Our donation is in honor of:

Mr & Mrs Ted BallisonHon. Donald X Clavin Jr ~ Community Leadership AwardEliana & Avi RaveJacob Scheiner ~ Young Leadership AwardRozana Zemlyansky ~ Woman of ValorRabbi & Rivkie Tenenboim
Ad text - To send artwork, email [email protected]
Additional Donation
Please use this opportunity to support the Chabad House and purchase raffle tickets for the Grand Raffle or by making a donation
I would like to make an ADDITIONAL Donation

$
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Paypal ACH, Check, Cash or Zelle

Postal / Zip Code

Country

I would like to receive news and updates by email
If you have any questions about the registration form, the Book of Birthday Wishes or you would rather RSVP over the phone please call Sharon at 516-295-3433.
Should be Empty:

This page uses TLS encryption to keep your data secure.

Gala Dinner