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The Hillels of Illinois Benefit 2008
Other: $ .00
 x $100 (to subsidize students' participation at the Benefit)
*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Day Phone:
(123-456-7890)
Evening Phone:
(123-456-7890)
*E-mail:
Total Number Attending:
I/We prefer vegetarian meal(s)
Please list your guest(s):

Seating request:

Donations of $300 or more received by June 13 will be recognized in the evening’s printed program. Please write on the line below how you would like to be listed in the evening's program:

* (indicates required field)