Event Reservation Form

Contact Information

Title

First Name

Last Name

Address

City

State

Zip

Phone

Tribute Journal Ad and Reservation Information

Text Ads can written in the section below, also please indicate below if you intend to use your reservations that come with your ad. If your ad is camera ready please email it to moshe@chabadpennwynne.org

Ads and Reservations	Number of ads/Guests	Amount	Total
Gold Builder Page (includes 10 reservations)		25000.00
Chai Builder Page (includes 10 reservations)		18000.00
Builder Page (includes 8 reservations)		10000.00
Pillar Page (includes 8 reservations)		5400.00
Diamond Page (includes 8 reservations)		3600.00
Gold Page (includes 4 reservations)		2500.00
Chai Page (includes 4 reservations)		1800.00
Bronze Page (includes 2 reservations)		1000.00
Full Page (includes 2 reservations)		613.00
Half Page		250.00
Quarter Page		150.00
Couple Reservation		350.00
Reservation		200.00
Total

	#	Ads and Reservations	Guest First Name	Guest Last Name

Reservation

Donation

Total Amount

Ad Text

Payment Information

If you intend to pay by check then please skip this section and just click the submit button below.

Card

Card Number

Card Expiration

Same as contact information

Name on Card

Billing Address

Zip Code

Security Code