Thank you for your support. Please use this donation page for the following items: Annual Dinner Building Fund CBM Keren Fund Special Sponsorship Dinner Donation Form If you are human, leave this field blank. First Name Last Name Spouse First Name If attending Email Address Phone Number * Donation Type * Kiddush & Shalosh Seudos Sponsorship Annual Dinner Hall Rental CBM Keren Fund Building Fund Special Sponsorship Dollar Amount * Number of Reservations * Enter "0" if you will not attend Journal Page Options * Ruby Page - $10,000 Diamond Page - $5,000 Sapphire Page - $3,600 Platinum Page - $1,800 Gold Page - $1,000 Silver Page - $500 Full Page - $400 Half Page - $200 Quarter Page - $125 Greetings - $75 Full page or higher entitles you to 2 reservations Journal Page Options * Ruby Page - $10,000 Diamond Page - $5,000 Sapphire Page - $3,600 Platinum Page - $1,800 Gold Page - $1,000 Silver Page - $500 Full Page - $400 Half Page - $200 Half page or higher entitles you to 1 reservation Full page or higher entitles you to 2 reservations Journal Page Options * Ruby Page - $10,000 Diamond Page - $5,000 Sapphire Page - $3,600 Platinum Page - $1,800 Gold Page - $1,000 Silver Page - $500 Full Page - $400 Full page or higher entitles you to 2 reservations Journal Ad Text Payment Method * Credit Card Check Credit Card * Credit Card Credit Card Credit Card Month 1 2 3 4 5 6 7 8 9 10 11 12 Credit Card Year 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 CVV CVV Billing Address * Billing Address Billing Address Billing Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country Please make checks payable to Bais Medrash of Cedarhurst and mail to: Bais Medrash of Cedarhurst 287 Linwood Avenue Cedarhurst, NY 11516 Additional Comments Submit