Congregation Rinat Yisrael

If you haven't already sent in your payment or reply card, please use the form below to RSVP for Rinat's Annual Dinner taking place on Sunday, March 3, 2013. Please indicate if you will be paying by check or if you will be contacting Adina at the shul office for payment by credit card (201-837-2795).

IMPORTANT: Please RSVP by February 15.

Email address: *

Contact phone #: *

Last Name: *

First Name(s): *

List the names of all those attending (e.g. Abraham, Sarah)

Attending Dinner: *

Yes

No

Donation: * select...Master Builder - $10,000Grand Builder - $5,000Benefactor - $3600Chai Donor - $1800Builder - $1000Patron - $750Sponsor - $500Sustainer - $400Supporter - $200Contributor - $100

I wish to donate at the following level ($400 and above includes 2 dinner tickets)

Payment Method: *

Credit (by phone)

Check by mail

In person

Please indicate if you wish to pay by credit card, by a mailed check, of if you will come into the office for payment.

Scroll Listing:

Please indicate how would you like to be listed on the Scroll of Honor

Seating Request:

Please list any seating requests here