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Reservation

Reservation
Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number
E-mail* Email Address
I would like to receive news and updates by email
Journal Ad & Reservation
Reservation*

Reservation & Journal Ad Reservation only Journal Ad only
Dinner Reservation

$375/person $750/couple
(Half Page and up receives a free dinner reservation of 2)
Journal Opportunities*

Founder Grand Master Builder* $100,000 Chazak Grand Master Builder* $54,000 Grand Master Builder* $36,000 Master Builder (G-D’s Name)* $26,000 Master Chai Builder* $18,000 Master Crown Builder* $10,000 Crown Builder* $7,500 Diamond Page* $5,000 Platinum Page** $3,600 Gold Page** $2,600 Silver Page** $1,800 White Full Page** $1,000 Half Page** $750 1/4 Page*** $375 1/8 Page $180
*Entitles you to a Table of 10
**Entitles you to 2 Dinner Reservations
*** Entitles you to 1 Dinner Reservation
How many will attend*
Seat me with
Names of all guests attending
In Honor of

Albert & Sherly Gorjian Gideon & Bita Gorjian Mr. Nehemia & Naima Z”L Naim Virginie & Russel Feder Sharon & Akiva Fishman Sanam & Harry Zubli
Dedication ad text

Logos will be accepted only if they are reproduction quality.
Your name how you would like it to appear on the ad
Email logos for your ad to [email protected]
Total

$0.00
Terms and Conditions*

I, the undersigned agree, understand and authorize the amount shown above to be charged to my credit card for the items shown on the referenced order. I understand these charges will appear on my credit card statement under my name and I accept full financial responsibility for payment of this order. I agree payments are non-refundable and services / merchandise have been rendered / delivered to my satisfaction.
By entering your email you are accepting the terms above*

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Journal Ad & Reservation