Chabad Gala Banquet

Chabad of the Conejo
Gala Banquet Concert
Monday, June 13, 2011, 5:30pm

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Reservations/Tribute Ads

	Tribute Ad Journal Form
	I would like to place a greeting in the Tribute Ad Journal: (please select your level of support) Life Partner $100,000 Platinum Pillar $72,000 Chabad Fellowship $50,000 Emerald Sponsor $36,000 Trustee Circle $25,000 Founders Guild $18,000 Diamond Club Table $10,000 Governors Table $5,000 Contributions of $5,000 or more include respective journal page plus option of table of up to 10 banquet reservations Crown Contributor $3,600 Jewel Society $2,600 Chai Founder $1,800 Golden Benefactor $1,000 Silver Patron $613 Contributions of $613 or more include respective journal page plus 2 banquet reservations Patron - Full Page Ad $400 (No dinner Included) Half Page Ad $250 (No dinner Included) Quarter Page Ad $125 (No dinner Included) Please accept our contribution toward your vital work: $

Dinner & Theater Reservations

Option 1

Gala Banquet Reservations included with
Tribute Journal Ad (selected on left side of this form.)

We will bringing a total of guests for the
Gala Banquet.

Option 2

Gala Banquet Reservation Only (No Tribute Journal Ad)

Amount of Reservations: ($270 per person)

Option 3

We are unable to attend the Gala Banquet
but we are placing a greeting in the
Tribute Ad Souvenir Journal (selected on left side of this form)

Personal Information

Name(s):

Address:

City:

State:

Zip:

Phone:

Ev. Phone:

Email:

Confirm Email:

Payment Information

Please send statement

Check sent, payable to: Chabad of the Conejo

Credit Card:

Visa Mastercard American Express

Please bill my credit card:

Monthly Quarterly Full Payment

Account Number:	CVC:	Expires:
Name (as it appears on the card):

Journal Ad Information

Enter your greeting below:

Actual Journal Full Page Size 8 x 10
Please mail camera ready ads to Gala Banquet, 30345 Canwood Street, Agoura Hills CA. 91301 - In the box above please indicate that camera ready material has been mailed.
If you would like to e-mail a camera ready greeting or advertisement,
please send to chabadbanquet@gmail.com.

Deadline for Submitting Ads - June 2, 2011 • For more information, please call 818-991-0991
For building dedication opportunities, please call Rabbi Bryski at 818-991-0991 or visit Chabadconejo.com/building

30345 Canwood St. . Agoura Hills, CA 91301
Tel: 818-991-0991 . Fax: 818-707-1190 Web:www.ChabadConejo.com E-Mail: info@chabadconejo.com