"A Time For Music" Chabad of Laguna Niguel's 5th Anniversary Concert Celebration Reservation Information First Name: Last Name: Address: City: State: Zip: Phone No: E-mail: I cannot attend but I am pleased to contribute I would like to be a sponsor! $100 - Includes 2 preferred concert seats* and listing in the Commemorative Journal sponsor's page ( Please indicate how you would like your name to appear in the space below) *Additional family members may be seated with sponsors at the regular ticket price I would like to purchase concert tickets: (enter amount) adult: $20 in advance - $25 at the door child under 13: $10 in advance - $15 at the door I would like to show my support for Chabad and/or recognition of Miles & Esther Sterling by placing an ad in the journal: full page ad ($1,000 - includes 4 preferred concert seats) half page ($500 - includes 4 preferred concert seats) quarter page ($250 -includes 2 preferred concert seats) business card ($150 -includes 2 preferred concert seats) listing ($100 -includes 2 preferred concert seats) Enter ad message below or email camera ready art to [email protected] This space may also be used for comments or questions. Total Amount $ I'd like to pay by check Please make your check payable to Chabad of Laguna Niguel. Mail to: Chabad of Laguna Niguel 27631 La Paz Rd #D Laguna Niguel, CA 92677 I'd like to pay by credit card (Our secure form uses 128 Bit SSL Encryption for your protection) To pay by credit card, please fill out the form below, otherwise, scroll to the bottom of the page and click "submit" to complete your reservation. Online Payment Information Card Type: Please select MasterCard Visa Amex Name on Card: Card No: CVV Security Code: What's This? Expiration Date: Billing Address: (if different from above) Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Total Amount: This page uses 128 bit SSL encryption to keep your data secure.