STEP 1 PERSONAL INFO

STEP 2 RESERVATIONS

First Name

Please select one of the following
Reservations & Honor Scroll
Reservations Only - $180 per person
Honor Scroll Only

How many will be attending?






Last Name
Address
City
State
Zip
Phone
E-mail
Note  

______________________________________________

STEP 3 SCROLL OF HONOR OPPORTUNITIES

1. Partner $18,000 incl 2 Tables
2. Benefactor $10,000 incl 1 Tables
3. Platinum $5,400 incl 1 Tables
4. Gold $3,600 incl 1 Tables
5. Silver Circle $2,500 incl 2 seats
6. Chai Circle $1,800 incl 2 seats
7. Bronze $1000 incl 2 seats
8. Supporter $500  
9. Sponsor $360  
10. Friend $180  
 
SPLIT THE POT RAFFLE
1 Ticket $25 | 5 Tickets $50 | 15 Tickets $100
     
The raffle will take place at the Gala Dinner
Sunday,
June 14, 2018

STEP 4 PAYMENT

Charge Amount * Comments (optional)
Card Type*
Card Number*
Expiration*
CVC CODE* What's This?