Click here for printable form. Your Information Name Company Address City State Zip Phone Number Email Advertising & Sponsorship Options Back Cover Page ........................ $1800 Banner 2x7 (Per month) ................ $360 Full Page 8x10 ............................ $1200 Business Card (Per Month) ........... $180 1/2 Page 8x5 ................................. $900 Month Dedication .......................... $180 1/4 Page 8x5 ................................. $500 Dedication Box................................. $54 Banner 2x10 (Per month) .............. $520 Rosh Hashana Greeting ...................$25 NEW! List up to 10 occasions for only $180! Savings of $70! Please include my family Birthdays/Yahrtzeits/Anniversaries - $25 Donation Name 1 Date 1 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 2 Date 2 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 3 Date 3 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 4 Date 4 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 5 Date 5 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 6 Date 6 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 7 Date 7 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 8 Date 8 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 9 Date 9 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Name 10 Date 10 Select Occasion Birthday Yahrtzeit Anniversary If Yahrtzeit was passing after sunset? Yahrtzeits will be recorded in the calendar on the Hebrew Date (i.e. Tishrei 1, 5781 etc.) on which the Yahrtzeit occurred. Check here to record these Yahrtzeits on the Secular Date. Birthdays will be recorded on the Secular Date (i.e. January 1, 2021). Check here to calculate and record these birthdays on the Hebrew Date. Rosh Hashana Greeting - $25 First Names Family Name Payment Information I will pay by Check Please Bill Me Pay by Credit Card Payment Plan Name on Card Card Number Expiration Date CVV Card Type Amount to Charge This page uses 128 bit SSL encryption to keep your data secure.