2020 Virtual Gala - Journal Form

I cannot attend the 2020 Virtual Gala but I would like to place an ad in the commemorative journal in honor of Scott Simon.  

First Name
Last Name
Email
Phone
Billing Address
City
State
Zip
COMMEMORATIVE JOURNAL
JOURNAL AD COPY:
Payment Method
Card Type
Card Owners Name
Card Number
CVV
Expiration Date
I would like to make a tax-deductible contribution in honor of Scott Simon to support the programming of UJA-JCC Greenwich (optional)
Total Amount