Calendar Form

BE SEEN IN CHABAD-HCW'S CALENDAR!

PLACE YOUR AD OR GREETING

OR

DEDICATE A DAY IN HONOR OF A LOVED ONE’S BIRTHDAY, ANNIVERSARY, OR YAHRTZEIT:
Full Name*

First Name Last Name
E-mail*
Phone Number*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Advertising & Greeting Options
Business Card Ad Months:
Calendar Sponsor - $1,800 [full page ad]

YesNo
Choose the format for text/PDF inclusions:

I will submit a pdf version of the ad to [email protected]Please design the ad for me - I will send the text of the ad to [email protected].
Text
PDF
Please include a Birthday/Yahrtzeit/Anniversary
Date Dedication Options
Honor your special day such as a birthday, anniversary, or mark a yahrtzeit by sponsoring that date in the calendar!

Select the occasion, insert the name (exactly as you'd like it to appear) and select the date. You can select the secular or Hebrew dates below. $36 per dedication. Sponsor 3 and get the 4th for free. Your dedication will appear as text in the calendar date box of choice.
How Many Occasions?
Occasion 1
Full Name

First Name Last Name
Occasion
Date

Month Day Year
Occasion 2
Full Name

First Name Last Name
Occasion
Date

Month Day Year
Occasion 3
Full Name

First Name Last Name
Occasion
Date

Month Day Year
Occasion 4
Full Name

First Name Last Name
Occasion
Date

Month Day Year
Please include a Greeting/Message
Include a customized greeting or message in the calendar. (Size= 2 calendar date boxes, about 2/3 size of business card. Greeting will appear in the blank date boxes before beginning or after end of the month.)
$100 per greeting/message.
How many greetings?
Greeting 1
Greeting/Message Text
Please select the month you would like your greeting/message to appear (optional):
Greeting 2
Greeting/Message Text
Please select the month you would like your greeting/message to appear (optional):
Greeting 3
Greeting/Message Text
Please select the month you would like your greeting/message to appear (optional):
Greeting 4
Greeting/Message Text
Please select the month you would like your greeting/message to appear (optional):
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Advertising & Greeting Options

Please include a Birthday/Yahrtzeit/Anniversary

Occasion 1

Occasion 2

Occasion 3

Occasion 4

Please include a Greeting/Message

Greeting 1

Greeting 2

Greeting 3

Greeting 4

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