Reservations BANQUET RESERVATION AND AD JOURNAL PLACEMENT FORMPlease complete the "AD IN HONOR OF" section, select an AD JOURNAL CATEGORY and compose your ad in the AD DETAILS section.AD IN HONOR OF*Please include my ad in the 25th Anniversary Commemorative Journal paying tribute to: (tributees will be notified, please check all that apply) Rabbi Eli and Chany Gewirtz - Guests of Honor Rabbi Greg Wall - Rabbinic Leadership Award Elysa Goldman - Young Leadership Award Dr. Linda Greenberg and Chava Willig Levy - Partners of the Year Chaya Schron and Leah Schapiro - International Partners of the Year In memory of Pearl Matlin A”H of blessed memory Other - Please specify In Honor or In Memory of... Ad In Honor or Memory Of (other):Please enter the name of the person(s) that your ad is In Honor or In Memory Of...AD JOURNAL CATEGORIESNote: Complimentary banquet reservations are included with most categories - see belowJournal Ad CategoryLegacy Partner Page [$50,000]***Benefactor Page [$25,000]**Chai Partner Page [$18,000]**Master Partner Page [$10,000]**Diamond Page [$5,000]**Platinum Page [$3,600]**Gold Page [$1,800]*Silver Page [$1,000]*Bronze Page [$800]*Full Page Ad [$600]*Half Page Ad [$360]Quarter Page [$180]Greeting [$100]* Full page and above includes dinner reservations for 2 ** Platinum and above includes 1 table (dinner reservations for 10) *** Legacy Partner Page includes 3 tables (dinner reservations for 30) BANQUET RESERVATIONSTo place reservations without an ad or for reservations in addition to those included with your ad, please indicate the number of reservations and then enter the full names of those attending in the Reservation Details box below.Your Legacy Partner Page Journal Ad includes dinner reservations for 3 tables of 10 (30 total). If you wish to order additional dinner reservations, you may add them to your order here:Your Benefactor Page Journal Ad includes dinner reservations for 1 table of 10. If you wish to order additional dinner reservations, you may add them to your order here:Your Chai Partner Page Journal Ad includes dinner reservations for 1 table of 10. If you wish to order additional dinner reservations, you may add them to your order here:Your Master Partner Page Journal Ad includes dinner reservations for 1 table of 10. If you wish to order additional dinner reservations, you may add them to your order here:Your Diamond Page Journal Ad includes dinner reservations for 1 table of 10. If you wish to order additional dinner reservations, you may add them to your order here:Your Platinum Page Journal Ad includes dinner reservations for 1 table of 10. If you wish to order additional dinner reservations, you may add them to your order here:Your Gold Page Journal Ad includes 2 dinner reservations. If you wish to order additional dinner reservations, you may add them to your order here:Your Silver Page Journal Ad includes 2 dinner reservations. If you wish to order additional dinner reservations, you may add them to your order here:Your Bronze Page Journal Ad includes 2 dinner reservations. If you wish to order additional dinner reservations, you may add them to your order here:Your Full Page Journal Ad includes 2 dinner reservations. If you wish to order additional dinner reservations, you may add them to your order here:Your Half Page Journal Ad includes 1 dinner reservation. If you wish to order additional dinner reservations, you may add them to your order here:Individual ReservationsEnter the number of individual reservations you wish to add. ($300 per reservation) Price: $300 Quantity: Sponsoring a Study Partner Check here if you are sponsoring your study partner to attend the banquet. (Complimentary or paid reservations may be given as a sign of appreciation) Additional DonationEnter any additional amount that you wish to contribute. Total to be charged to your credit card $0 AD DETAILS Compose your message here as you would like it to appear in the journal. You may also upload a PDF file of your message or company logo here. Maximum file size is 20 MB. (Ideal file format is PDF or you may also upload a JPG, GIF, or PNG file.)Ad FileAccepted file types: pdf, jpg, jpeg, gif, png.Ad Content (Text)RESERVATION DETAILSPlease list full names of banquet attendees and any seating requests (we will attempt to accommodate those requests to the best of our ability).Contact / Billing InformationName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Cell Phone*Email* Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Total to be charged to your credit card $0
