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I'd like to reserve for the Chabad Virtual Gala 
Name(s):  
Email: 
Suggested Donation: $250
Other: 
 
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 Platinum Level...........................$10,000* (Double 7x9)  Silver Level.......................................$600 (7x9)
 Diamond Level.............................$5,000* (Double 7x9)  Copper Level..................................$350 (7x4.5)
Sapphire Level........................................$3,600** (7x9) Bronze Level...................................$200 (3x4.5)
Pearl Level...............................................$1,800** (7x9) Other.................................................
 Gold Level...............................................$1,000** (7x9)  
 
Please include ad text below or email artwork to [email protected]
 
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Title    
First Name Last Name

Address City
State Zip
       
Card Type Card Number
Expiration Date Security Code
TOTAL    
       
To help defray your processing costs, please add $0.25 + 3% to the donation as an added gift.