Benefit Check/Communal Fund To purchase tickets and sponsorships by credit card, click here. To return to the previous page, click here.Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Phone*Email* Tickets and Sponsorships* $50,000 – Builder (Call 866-474-2774 to purchase) $25,000 – Guardian (Event access for up to 10) $18,000 – Partner (Event access for up to 10) $10,000 – Benefactor (Event access for up to 10) $5,000 – Patron (Event access for up to 10) $2,500 – Pioneer (Event access for up to 2) $1,800 – Leader (Event access for up to 2) $1,000 – Supporter (Event access for up to 2) $500 – Friend (Event access for up to 2) $360 – Bronze (Event access for up to 2) $180 – Ticket Price With a donation of $5,000 and above, we welcome you to Sharsheret’s exclusive Jewel Circle. Learn more at Sharsheret.org/jewelcircle. For recognition on the virtual event site and to receive the snack box in time for the event, mailed and online responses need to be received by November 10th.My gift will be made by:* Check Communal Fund Stock Transfer Attending?* Yes No Number of attendees12345678910Please add the names and email addresses of all guests.*Guest names not yet confirmed? Please enter any guest information you can at this time, and we will be in touch for the remainder. All guest names and email address must be submitted in advance to receive event access.Program Listing for Gifts of $360 or more: Hidden Please donate back my Sharsheret gift and snack box to someone in need. Sharsheret gift and Snack Boxes:Please let us know where we should send your Sharsheret gift (for gifts of $500 and above) and snack boxes (for gifts of $1,800 and above)My contribution is in honor of: Select All Kim Molstre Robin Struhl Casey and Alyson Winderbaum Dana Norris and Dr. Stanley Frankel Check here to make your gift in memory of Sharsheret's Founder Rochelle Shoretz. Check here to make your gift in honor/memory of a loved one. Please contact me for more information about my employer’s matching gift program. I am interested in learning more about Sharsheret’s Legacy Giving program. Type of tributeIn honor ofIn memory ofSend notification to:Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Please send your payment to Sharsheret's National Office at 1086 Teaneck Road, Suite 2G, Teaneck, NJ 07666.