Journal Ad Rates
Full page ad or more includes admission for two to the Dinner.
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Please make reservations at $180 per person.
Other Donation $
  Order Total: $
Ad Information
In Honor Of
Jeanne & Isaac Warman
Dr. & Mrs. Simon & Irit Lipetz
Dr. & Mrs. Jacob & Chaya Schachter
Dr. Stephen Glicksman
Mr. & Mrs. Harry & Ruth Senior & Family
Daniel Chill, Esq.
Ad Text:
Personal Information
First Name: *
Last Name: *
Company Name:
Address: *
City: *
State: *
Zip Code: *
Country: *
Phone Number: *
Cell Phone:
Email Address: *
Names of Guests Attending
Seating Preferences
Seating Location:
Family Seating Separate Seating
Please seat me/us with:

Payment Details
Card Type: *
Card Number: *
Exp. Month: *
Exp. Year: *
Security Code: *
3 or 4 digit security code.
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Please mail a receipt to the address above (in addition to the receipt I will receive via email).

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Women's League Community Residences, Inc. is a non-profit 501(c)(3) organization.

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