2022 Netivot Shalom Annual Dinner - Form

RSVP BY JUNE 1 FOR INCLUSION
IN THE SCROLL OF HONOR
RSVP DEADLINE: JUNE 11

* First Name

* Last Name

* Email

* Phone Number

Address

* City

State

Zip Code

We will be printing a Scroll of Honor (names only) with the directory booklet which will be given out at the dinner.

Any donation above $500 will have the option to add a personal message to our honorees. These will be printed and given to the honorees separately.

Please enter an amount:

Payment Options

After you submit this for you will have the option to pay by ACH/E-Check or PayPal/Credit Card. Please note that payments made via PayPal or credit cards will have a service fee added.

Members who want to pay by check, please select "Bill to Account" on the payment screen and mail your check by June 1. You must be logged into your account to bill to account. Click the "Login" dropdown on the top right of this screen to login.

If you are not a member of Netivot Shalom and will be paying by check, please do not submit this form. Instead email Rachel Cohen with the information required in the form so it can be entered on your behalf.

Checks should be mailed by June 1 to Netivot Shalom, Attention Dinner Committee, 811 Palisade Ave, Teaneck, NJ 07666. Please email your RSVP before mailing a check.

* How would you like your name(s) listed in the Scroll of Honor?

Please enter your scroll message to the honorees (300 character max):

All messages will be shared with the honorees. Messages will not be printed in the Scroll of Honor.

* Thank you for your gift. Will you be joining us for the dinner?

* How many people are you reserving seats for?

Please enter the names of the people attending the dinner

Your total gift is

Thank you for your generous support.