Partners Circle Form

*

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

Full Name*

First Name Last Name

Birth Date*

Month Day Year

E-mail*

Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Spouse Name

First Name Last Name

Spouse Birth Date

Month Day Year

Partnership Annual Contributions:*

Premier Partners Circle: $5,400 (Includes all from Executive Partners Level plus two weeks of Challah Delivery, two Kiddushim and Yizkor Book Listings)Executive Partners Circle: $3,600 (included fees for all programs throughout the year, excluding tuition for CHS and CGS)Partner: $1,200

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

One-time paymentTwo equal amounts (first payment now and second in six months)12 equal payments of (on the first of every month)

Security Fund

$200

Total to be charged today:*

$

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card Paypal Payment Installments

Postal / Zip Code

Country

Partner Information

Partnership Information