Chabad Young Professions Pre Shabbat BBQ

Personal Information

First Name *

Last Name *

Please be sure to write your FULL street address and apartment number if applicable

Street Address *

City (Primary) *

State (Primary)

Email *

Phone *

Sponsorship Option

Optional Donation amount

Chai Friend - $ 18.00 (includes Sales Tax of $ 0.00)

Sponsor - $ 36.00 (includes Sales Tax of $ 0.00)

Bronze - $ 54.00 (includes Sales Tax of $ 0.00)

Silver - $ 180.00 (includes Sales Tax of $ 0.00)

Gold - $ 360.00 (includes Sales Tax of $ 0.00)

Platinum - $ 1,800.00 (includes Sales Tax of $ 0.00)

Not this time - $ 0.00 (includes Sales Tax of $ 0.00)

- none -

Other Amount

Total

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

info@stamfordchabad.org | 203-3CHABAD | 770 High Ridge Road Stamford, CT 06905-2308