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Partners Circle

*
Yes, I/we would like to partner with Lubavitch of Montgomery County.
Full Name*
First NameLast Name

Address*

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

Phone Number*
Area CodePhone Number
E-mail*
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: $1,200Senior: $1,000Single Parent Family: $1,000Single: $1,000
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 Fee:
$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

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