Backup - Dinner 2014 form

Your Name:

Street Address:

City / State:

Zip Code:

Email Address:

Guests:
   

I am unable to attend but would like to support Chabad's important work.
Contribution amount:  

Cost: $250 per Reservation.

Please make:  reservations at $250 per person. 

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Sponsorship Opportunities: 

Ticket: $250
Partner: $1,000
Patron: $5,000
Pillar: $10,000
Gold Sponsor: $18,000 

Total Price:  

Credit Card Type:

Card Number:

Expiration Date: (xx/xxxx)

Billing Zip Code: