Tributes & RSVP1. ReservationsFull Name*First NameLast NamePhone Number*Area CodePhone NumberE-mail*Address*Street AddressStreet Address Line 2CityState / ProvincePostal / 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 GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern 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 LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryCompany NameWill attendGala reservation is included with half page (or higher) journal ad.Gala dinner reservation ($180 per person)Number of Gala Dinner Reservations (not included in journal ad)$180 per personPlease list dinner guests below:(If not attending write N/A above)Unable to attendBut would like to place an ad in the tribute journal2. Tribute OpportunitiesSelect One:Event Host (Includes event host dedication, a room dedication in the Hospitality House, back-cover journal page, a private reception with Dennis Prager and two reserved tables) [$100,000]Champion of Hope (Includes a room dedication in the Hospitality House, a champion of hope journal page, a private reception with Dennis Prager and two reserved tables) [$50,000]Founders of Hope (Includes Shabbat table dedication in the Hospitality House, founder of hope journal page, a private reception with Dennis Prager and two reserved tables) [$36,000]Pillar of Hope (Includes a Shabbat seat dedication in the Hospitality House, a pillar of hope journal page, a private reception with Dennis Prager and one reserved table) [$18,000]Diamond of Hope (Includes a dedication of two gala dinner tables, diamond of hope journal page, a private reception with Dennis Prager and one reserved table) [$10,000]Platinum (Includes a dedication of one gala dinner table, a platinum journal page, a private reception with Dennis Prager and six reservations) [$5,000]Gold (Includes gold journal page and six reservations) [$3,600]Ruby (Includes ruby journal page and four reservations) [$1,800]Full Page (Includes a full page journal ad and two reservations) [$1,000]Half Page (Includes a half page journal ad and one reservation) [$500]Choose your own contribution amount$Write the text of your Event Journal ad here:All camera-ready designs, including business cards, must be submitted in hi-res JPEG, PDF or PSD format to [email protected] . Designs can be either black and white or full color. You can also submit your ad text using the designated box above. Full Page 8 1/2" x 5 1/2" | Half Page 4 1/4" x 5 1/2" | Quarter Page 4 1/2" x 2 3/4"3. PaymentTotal$0.00PaymentCredit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2018201920202021202220232024202520262027Expiration YearSubmitShould be Empty: This page uses TLS encryption to keep your data secure.