1. Ad Journal Form Journal Ad Options Please contact me about my gift Contact me about sponsoring one of The 5 Books of The Torah Builders Page* (includes a dedicated Parsha) . . . . . . . . . . . . . . . . . . . . . . . .$5,000 Governors Page* (includes a dedicated 1/2 Parsha) . . . . . . . . . . . . . . . . . . . $3,600 Benefactor Page* (includes a dedicated Chapter) . . . . . . . . . . . . . . . . . . . . . $2,500 Crown Sponsor* (includes a dedicated Aliya). . . . . . . . . . . . . . . . . . . . . . . . . $1,800 Sar Haelef [4 Dinners]* (includes a dedicated Column) . . . . . . . . . . . . . . . . . $1,000 Gold Page [2 Dinners]* (includes a dedicated Verse) . . . . . . . . . . . . . . . . . . . . .$600 Silver Page [1 Dinner] (includes a dedicated Word) . . . . . . . . . . . . . . . . . . . . . $360 Full Page (includes 2 dedicated Letters). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250 Half Page (includes a dedicated Letter). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$150 Ad Blank Please print greeting or business ad in this box. Text or high resolution pdf (8”x8”) can be emailed to [email protected] 2. Dinner Reservations I would like to RSVP now Reservation Type: We are delighted to attend. We are unable to attend but would like to place a greeting in the dinner journal. Please accept our contribution towards your vital work. Number of Reservations: $150 per person Guest 1 First Name Last Name Guest 1 Meal Fowl Fish Vegetarian Guest 2 First Name Last Name Guest 2 Meal Fowl Fish Vegetarian Guest 3 First Name Last Name Guest 3 Meal Fowl Fish Vegetarian Guest 4 First Name Last Name Guest 4 Meal Fowl Fish Vegetarian Any Comments / special requirements *Dinner tickets included according to amount of contribution. Dinner reservations are confirmed by filling out reservation form above. Your ad can be a tax-deductible business advertising expense or a charitable contribution. 3. Your Information Full Name* First Name Last Name E-mail* Phone Number* Area Code Phone Number 4. Payment Total to pay now $ Payment Credit Card Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Expiration Year Please make check payable to: CHEDER LUBAVITCH HEBREW DAY SCHOOL 5201 Howard Street, Skokie, Illinois 60077 Tel 847-675-6777 • Fax 847-674-6095 Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Add to mailing list Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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