Donation Form
Select a Donation Category
Type of Donation
*
Founder’s Page (Ruby).............................$25,000 - Journal Ad and dinner tickets
Master Builder’s Page (Emerald)................$18,000 - Journal Ad and 10 dinner tickets to dinner
Builder’s Page (Sapphire)..........................$10,000 - Journal Ad and 10 dinner tickets
Diamond Page ..........................................$5,000 - Journal Ad and 10 dinner tickets
Platinum Page ..................................... ......$3,600 - Journal Ad and 8 dinner tickets
Gold Page ..................................................$1,800 - Journal Ad and 6 dinner tickets
Silver Page .................................................$1,000 - Journal Ad and 4 dinner tickets
Full Page ......................................................$500 - Journal Ad and 2 dinner tickets
1/2 Page ......................................................$300 - Journal Ad and 1 dinner ticket
1/4 Page ...........................................................$200 - Journal Ad
Greetings .............................$100 - Name Listing in our Journal One/Two Lines of Text
Young Leadership Table - Suggested Donation $120 per person or $200 per couple
Contribution but not attending - We/I are happy to support the organization with a gift of
Attending -- See my "Reservation Details" below. We/I are happy to support the organization with a gift of
Select your Dinner Reservation or Donation Category
*
Please Select
Founder's Page (Ruby) ........................$25,000
Master Builder's Page (Emerald) .........$18,000
Builder's Page (Sapphire) ...................$10,000
Diamond Page .....................................$5,000
Platinum Page .....................................$3,600
Gold Page ...........................................$1,800
Silver Page ..........................................$1,000
Full Page ................................................$500
1/2 Page ................................................$300
1/4 Page ................................................$200
Greetings ...............................................$100
Full Page ................................................$500
Young Leadership Table
Contribution but not attending
Attending -- See my "Reservation Details" below.
Billing Information
Billing Information
Full Name
*
First Name
Last Name
Registration Email Address
*
Confirm Email Address
*
Address
*
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Country
Phone Number
*
-
Area Code
Phone Number
Attendee / Donor Information
Attendee / Donor Information
Attendee / Donor Full Name
*
First Name
Last Name
The above telephone number is
*
Cellular
Home
Work
My second phone number is
Reservations Details
Reservations Details
Attending -- Please select:
*
I do not wish to place an ad
I am placing an ad but will enter Special Instructions in the box below
I am a guest and will enter the name below
Number of reservations being made: (Entitled to Complimentary Dinners) -- Please enter your number below.
*
Please list the names of all Attendees and Guests in a separate box.
*
Do you have any particular seating preferences (sit with friend, etc)? -- Please be advised that seating assignments cannot be guaranteed for any reservations made on, or after, December 1st. Every effort will be made to accommodate your preferences, and we appreciate your understanding and support. See you on Sunday!
Please select the name of the person who directed you to our website
*
Rabbi Yehuda Bohrer, PhD
Baruch Gordon
Yaakov "Ketzaleh" Katz
Other
Other -- Please write in the name of who directed you to our website.
Special Instructions -- (Attention Guests -- Please indicate the name of the person paying for you and select the "Payment by check" option [in the Payment Information section below] and you will not be billed.)
Ad Journal Details
Ad Journal Details
Enter Ad copy or listing or check box below.
If you wish to send camera ready ad, let us know of your intent by checking the box below. Full page ad dimensions are 6" x 9" (live area) centered in a 8.5" x 11" page. The ad pages have borders that we are printing. Supply Press-Optimized PDF, 300 dpi, grayscale, with all fonts embedded and converted into outline vector art. Please supply crop marks,:
Send the PDF file including the name used to place this reservation to afbeyc@ix.netcom.com
Payment Information
Payment Information
Payments by check should be mailed to: E. Gluck Corp New Address
Payment by check -- I have opted to pay by check and will mail it to
Payments by check should be mailed to:
E. Gluck Corp
New Address
Payment by Credit Card
Payment by Credit Card will be entered after you submit your information on the next screen.
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