Donor Information
Mr.
Mrs.
Ms.
Rabbi
Dr.
Mr. and Mrs.
Other
Title
Other
First Name
Last Name
Email
Phone/Cell*
Phone/Cell
Address Information
Address
City
State
Zip Code
Country
In Honor Of
Dr. Steven Flanagan - Physician Leadership Award
Richard and Frieda Bobo - Distinguished Service Award
Rabbi Shmuel and Tzippy Friedler - Community Impact Award
BINA Staff
Other
Journal Opportunities
AMBASSADOR
$100,000
VISIONARY
$72,000
GUARDIAN
$50,000
BENEFACTOR
$36,000
CHAI CHAMPION
$18,000
PATRON
$10,000
BUILDER*
$5,000
SUPPORTER
$3,600
CHAI FRIEND
$1,800
FRIEND
$1,000
DONOR
$720
FULL PAGE
$500
HALF PAGE*
$360
QUARTER PAGE*
$200
EIGHTH PAGE
$100
Other
* $5,000 and above includes a reserved table of 10
* $360 and above includes 2 dinner reservations
* $200 and above includes 1 dinner reservation
Reservations
Are you making reservations?
Yes
No
Attendee
Attendee
Please Check here for separate seating
Please email reservations to
dinner@binausa.org
Journal Ad
Please repeat last year's ad
Please prepare an ad on my behalf (text is at BINA's discretion)
Enter Text Below*
*Please include your name with the text or indicate if you wish the ad to be anonymous.
Payment Information
Total:
Cardholder Name
Card Number
1
2
3
4
5
6
7
8
9
10
11
12
Expiration Month
2019
2020
2021
2022
2023
2024
2025
2026
2027
Expiration Year
Zip Code
CVV
Please mail a receipt in addition to the email receipt
Submit
