Reservations and Sponsorships

Sponsorships
$10,000
$5,000
BE A CHAI LIFELINE MIDWEST SUPERHERO
$3,600
$2,500
$1,800
$1,000
$500
Other Donation
$
Reservation INFO

Names of people attending program:

Referred By:
  Order Total: $
 
Personal Information
First Name: *
Last Name: *
Company Name:
Address: *
City: *
State: *
Zip Code: *
Country: *
Phone Number: *
Cell Phone:
Email Address: *
Payment Details
Card Type: *
Card Number: *
Exp. Month: *
Exp. Year: *
Security Code: *
3 or 4 digit security code.
Please mail a receipt to the address above
(in addition to the receipt I will receive via email).

Only enter this field if you were told to do so by a staff member.
Chai Lifeline Midwest is a non-profit 501c3 organization.
© 2018 Chai Lifeline
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