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 Information 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): Questions or comments This page uses 128 bit SSL encryption to keep your data secure.