Name(s) as you wish to appear in ad *

First Name

Last Name

Phone *

(###)

###

####

Journal sponsorship opportunities *

High Rollers Circle (Rabbi's Circle) (includes 10 seats) $18000

Jackpot (Diamond Page) (includes 6 seats) $10000

Royal Flush (Platinum Page) (includes 6 seats $5400

Full House (Gold Page) (includes 4 seats) $3600

Lucky Streak (Silver Page) (includes 2 seats) $2200

Winning Hand (White Page) (includes 2 seats) $1500

Split Pot (Half Page) (includes 1 seat) $900

Side Bet (Quarter Page) $500

Lucky Note (Single Line Notes) $180

No journal ad

Other - Please indicate amount as additional donation at bottom of form

Name of first gala attendee

First Name

Last Name

Name of additional attendee

First Name

Last Name

Entree choice - choose one for attendee 1 *

Regular

Fish

Vegetarian

Not attending

Entree choice - choose one for attendee 2 *

Regular

Fish

Vegetarian

Only one attendee

Not attending

Payment *

I will send a check to the office

Bill my account

Charge my credit card on file