Please scroll down to RSVP Full Name* First Name Last Name E-mail* Phone Number* Area Code Phone Number * Yes! I will be attending the Gala Sorry, i cannot attend, please accept my donation below # of reservations Couvert $36 0 1 2 3 4 5 6 7 8 9 Yes! I would like to be a sponsor for: $180 Chai Sponsor $500 Event Sonsor $1000 Woman of Valor Sponsor Payment* Credit Card Paypal Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Expiration Year Paypal has been selected. Payment will take place on the next page. Please send check to: Chabad of Islip 102 E Main St Bay Shore, NY 11706 Total* $ Submit Should be Empty: This page uses TLS encryption to keep your data secure.