Calendar Dedication Page

$18 for each dedication. $100 for 6-8

Number of Dedications *

1 - $ 18.00

2 - $ 36.00

3 - $ 54.00

4 - $ 72.00

5 - $ 90.00

6 - $ 100.00

7 - $ 100.00

8 - $ 100.00

Total Amount

Profile

First Name

Last Name

Street Address

City

State

Postal Code

Phone

Details of your dedication* Please put commas between each dedication. (e.g. Stan Brooks birthday 5 June 2002, Molly Lewis Yahrzeit June 9, 2021 before sunset, (Sivan 29, 5781).

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

CHABAD OF STAMFORD - JEWISH CENTER FOR LIFE AND LEARNING

info@stamfordchabad.org | 203-3CHABAD | 770 High Ridge Road Stamford, CT 06905-2308