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RJC Journal Ad Form

Reservations $250 per person. Reservations, except for dinner cost of $100 per person, are a tax deductible contribution. Please list guests and tribute below.

• $3600 and above in ads entitles you to ten dinner reservations
  
• $750 and above in ads entitles you to two dinner reservations
  
• $375 in ads entitles you to one dinner reservation

First Name:
Last Name:
Address:
City:
State:	Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	(ZIP Code)
Phone:	(Phone Number)
Fax :	(Phone Number)
Email:	(E-mail)
Ad Size: (Please CLICK on one of the choices)	Chai: $18000 Benefactor: $10000 Platinum: $7200 Emerald: $5400 Sapphire: $3600 Diamond: $2500 Gold Page: $1800 Silver Page: $1200 Full Page: $750 Young Couples Full Page: $400 Half Page: $375 Quarter Page: $180 Eighth Page: $100 One Line Greeting: $72
Ad Copy:
Attending:	Yes No
Number of Reservations:
Method of Payment:	Online Payment via Credit Card I will send a check made payable to the RJC
Security:	Type the characters you see in the picture below.

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