Gala Donation / Payment

A high quality Jewish education is the best way to ensure the future of the Jewish people. Your gift will strengthen Robert M. Beren Academy which prepares our children to build the Jewish community of tomorrow and carry on the traditions that are close to your heart.

Please complete the following information. When you are finished, click Submit to enter your donation. Thank you for supporting Robert M. Beren Academy with your gift. If you need assistance, call 713-723-7170 or email rjacobson@berenacademy.org.

Contact Information

* Title:

* First Name:

* Last Name:

Maiden Name:

Spouse Title:

Spouse First Name:

Spouse Last Name:

* Address 1:

Address 2:

* City:

* State and Zip:

* Country:

New Address

* Phone:

Home Work Cell

* Email:

An email confirmation will be sent to this address when your gift has been submitted.

Affiliation with RMBA:

Alumni
Alumni Parent
Faculty/Staff
Parent
Grandparent
Other

Alumni/Alumnus
Class Year(Optional):

Donation Information

$100,000 Founder ( Page + Priority Table for 10 )
$50,000 Benefactor ( Page + Priority Table for 10 )
$36,000 Guardian ( Page + Priority Table for 10 )
$25,000 Platinum ( Page + Priority Table for 10 )

* To make a fund at the Platinum level or higher, please contact Rachel Jacobson Gold at 713-723-7170 x231 or rjacobson@berenacademy.org

Quantity	Level
	$18,000 Gold ( Page + Table for 10 )
	$10,000 Silver ( Page + Table for 10 )
	$ 5,400 Bronze ( Page + Table for 10 )
	$ 2,400 Ruby ( Page + 2 Priority Seats )
	$ 1,000 Emerald ( Page )
	$ 500 Pearl ( Half Page )
	$ 180 Sapphire ( Third Page )
	$ 100 Topaz ( Quarter Page - Business Card )
	$ 50 Amethyst ( Eighth Page - Message Box )
	$ 18 Opal ( Ad Line for Students and Teachers )
	$ 250 Individual seat
	$ 100 per Academy graduate or current RMBA student
	Unable to attend but I/we wish to make a scholarship donation

Please click here if you would like to add 3% to your donation/ad purchase to offset the cost of the credit card processing fees.
Clear additional 3%

*Total fund/Donation Amount to be charged $

Please print your guests' names and dinner preferences (beef, chicken, or fish):

Ad Journal Information

The size of the Ad Journal is 5 ½ x 8 ½ inches.
Ad text is due no later than Monday, January 15, 2012

Please type message text in the box below. Any graphics or business cards should be emailed in print ready format to adjournal@berenacademy.org.

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