Your Information Full Name* First Name Last Name Company Name Optional E-mail* Phone Number * Reservations & Tribute Journal AdReservations OnlyTribute Journal Ad Only Tribute Book AdsThe due date for all Tribute Journal Ad submissions is Friday, Dec. 26th * Platinum Page - $75,000 - Includes 10 SeatsDiamond Page - $54,000 - Includes 10 SeatsPillar Page - $36,000 - Includes 10 SeatsBenefactor Page - $25,000 - Includes 10 SeatsChai Founder Page - $18,000 - Includes 10 SeatsBar/Bat Mitzvah Page - $13,000 - Includes 10 SeatsBuilder Page - $10,800 - Includes 10 SeatsSustainer Page - $7,200 - Includes 10 SeatsTriple Chai Page - $5,400 - Includes 2 SeatsDouble Chai Page - $3,600 - Includes 2 SeatsGold Page - $1,800 - Includes 2 SeatsSilver Page - $1000 - Includes 2 SeatsFull Page - $720Half Page - $360Quarter Page - $250 Ad Text* Send ad PDF or JPG to [email protected] In Honor Of The Weinman Jewish Academy & Roberta Weinman OB”MYan & Valerie KlatsAria Babayev Reservations Number of attendees* $250 per person Please list your attendees (max 10)* 10 attendees are included in your sponsorship Please list your attendees (max 2)* 2 attendees are included in your sponsorship Please list your attendee* 1 attendee is included in your sponsorship If possible, please seat me with: Please ask the other party to request you too. Optional donation amount: Payment arrangements can be made with donations over $5000 $ Total $0.00 Payment plans are available. Please email [email protected] for more information. 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Payment will take place on the next page.PLEASE MAKE CHECKS PAYABLE TO:\n Chabad of New Canaan\n137 Putnam Road, New Canaan, CT 06840\nPhone: 203.972.7708 | Email: [email protected]Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.