Partners Circle

Partners Circle Form

Yes, I/we would like to partner with Lubavitch of Montgomery County.

Name:

Last Name:

Address:

City: State: Zip:

Phone Number:

Email:

Partnership Annual Contributions:

Executive Partners Circle: $3,000 (included fees for all programs and sponsorships throughout the year, excluding tuition for CHS and CGS)

Family: $1,200

Senior: $900

Single Parent Family: $900

Single: $750

Alternative Contribution:

I/we would like to make our Partnership contribution in….

One-time payment

Two equal amounts of (first payment now and second in six months)

12 equal payments of (on the first of every month)

Other

Building Fund Countribution

Visa Mastercard American Express

Card Number:

Expiration Date mm/yyyy: /

CSV(digit ID on card):