Graduation & Alumni Reunion Dinner Ticket and Journal Ad Form

Venmo/Check Payment Received? (Internal Use Only)

Yes
Graduation & Alumni Reunion Dinner Ticket and Journal Ad Form
You have the option to purchase the following on this form:
- One (1) Full Page Journal Ad and Two (2) Dinner Tickets: $500
- Dinner Ticket(s): $125 per person
- Journal Ads:
  - One (1) Full Page Ad: $350
  - One (1) Half Page Ad: $250
  - One (1) Quarter Page Ad: $175
*Note: If paying by credit card, an additional processing fee will be added to your payment.
Contact Information
Organization Name:
Contact Name:*

First NameLast Name
Email Address:*
example@example.com
Phone Number:*
Please enter a valid phone number.
I am purchasing:*

One (1) Full Page Journal Ad and Two (2) Dinner Ticket PackageJournal AdDinner Ticket(s)Both Dinner Ticket(s) & A Journal Ad

Dinner Ticket Information
Are you attending the Dinner or are your registering on someone else's behalf?*

YesNo, I am registering someone else
Name of Guest Attending:*

First NameLast Name
Are you purchasing additional dinner tickets? (Please do not include yourself)*

YesNo
How many dinner tickets are you purchasing?*
Name of Guest 1 Attending:*

First NameLast Name
Name of Guest 2 Attending:*

First NameLast Name
Name of Guest 3 Attending:*

First NameLast Name
Name of Guest 4 Attending:*

First NameLast Name
Name of Guest 5 Attending:*

First NameLast Name
Name of Guest 6 Attending:*

First NameLast Name
Name of Guest 7 Attending:*

First NameLast Name
Name of Guest 8 Attending:*

First NameLast Name
Name of Guest 9 Attending:*

First NameLast Name
Name of Guest 10 Attending:*

First NameLast Name

Journal Ad Information
Full Page Ad Size: (4 1/2”W x 7 1/2”H)

Half Page Ad Size: (4 1/2”W x 3 1/2”H)

Quarter Page Ad Size: (2”W x 3 1/2”H)
Journal Ad Size*

Full Page Ad: $350Half Page Ad: $250Quarter Page Ad: $175
Are you providing the art for the ad?*

YesNo, I need my ad designed
Journal Ad Art (jpg, jpeg, png files accepted; Must be at least 300 dpi)*

Cancelof
Do you want to provide your logo?*

YesNo
Logo File Upload*

Cancelof
Full Page Ad Message (Limit 70 Words)*

0/70
Half Page Ad Message (Limit 40 Words)*

0/40
Quarter Page Ad Message (Limit 25 Words)*

0/25

Payment Information
I am submitting my payment by:

CheckCredit CardVenmo
Total Amount Due (Check/Venmo): (Dinner Tickets)
Total Amount Due (Check/Venmo): (Journal Ad)
Total Amount Due (Check/Venmo): (Journal Ad & Dinner Tickets)
Total Amount Due (Check/Venmo): (Package)
Checks should be made out to: Leadership Rockland and mailed to PO Box 459, New City, NY 10956. Your check must be received by June 7, 2024 in order for your ad to be included in the journal.

As soon as we receive your payment, we will email you confirmation that payment has been received. Thank you!
Venmo payments should be directed to: @LeadershipRockland Your Venmo payment must be received by June 7, 2024 in order for your ad to be included in the journal.

As soon as we receive your payment, we will email you confirmation that payment has been received. Thank you!

Journal Ad and Dinner Ticket Purchase Information*

Full Page Journal Ad & Two (2) Dinner Tickets Package$500 plus a credit card processing fee.

$515.24

Full Page Journal AdIndividual journal ad purchase- $350 plus a credit card processing fee.

$360.76

Half Page Journal AdIndividual journal ad purchase- $250 plus a credit card processing fee.

$257.58

Quarter Page Journal AdIndividual journal ad purchase- $175 plus a credit card processing fee.

$180.54

Dinner TicketsIndividual dinner tickets for purchase- $125 per ticket plus a credit card processing fee.

$129.04 Quantity

Total

$0.00

Contact Information