Shulamith Annual Dinner Registration Form 2025

Registration Form

Please register using the form below, making sure to fill out ALL of the required information and specifying how many guests will be in attendance.
Full Name*

First NameLast Name
E-mail*
Phone Number*
Registration & Donation Levels

*Donations of $1,200 or more will receive a special gift AND **Donations of $1,000 or more will be included on the Scroll of Honor
Please select your registration category below:
(if unsure, please email cshrem@shulamith.org)
Shulamith Parent | Please select your desired registration/donation*

Pillar Sponsor* ($100,000) Pillar Page & 10 Dinner ReservationsCorporate Sponsor* ($75,000) Corporate Sponsor Page & 10 Dinner ReservationsBenefactor* ($50,000) Benefactor Page & 10 Dinner ReservationsGuardian* ($36,000) Guardian Page & 8 Dinner ReservationsRegency* ($25,000) Regency Page & 8 Dinner ReservationsChai* ($18,000) Chai Page & 6 Dinner ReservationsPatron* ($10,000) Patron Page & 6 Dinner ReservationsDiamond* ($5,000) Diamond Page & 4 Dinner ReservationsPlatinum* ($3,600) Platinum Page & 4 Dinner ReservationsGold* ($2,500) Gold Page & 4 Dinner ReservationsSilver* ($1,800) Silver Page & 2 Dinner ReservationsBronze* ($1,200) Bronze Page & 2 Dinner ReservationsEmerald** ($1,000) Full Page & 2 Dinner ReservationsPearl ($750) Half Page & 2 Dinner Reservations
Deduct my prepaid Shulamith Parent dinner obligation
Shulamith Faculty | Please select your desired registration/donation*

Pillar Sponsor* ($100,000) Pillar Page & 10 Dinner ReservationsCorporate Sponsor* ($75,000) Corporate Sponsor Page & 10 Dinner ReservationsBenefactor* ($50,000) Benefactor Page & 10 Dinner ReservationsGuardian* ($36,000) Guardian Page & 8 Dinner ReservationsRegency* ($25,000) Regency Page & 8 Dinner ReservationsChai* ($18,000) Chai Page & 6 Dinner ReservationsPatron* ($10,000) Patron Page & 6 Dinner ReservationsDiamond* ($5,000) Diamond Page & 4 Dinner ReservationsPlatinum* ($3,600) Platinum Page & 4 Dinner ReservationsGold* ($2,500) Gold Page & 4 Dinner ReservationsSilver* ($1,800) Silver Page & 2 Dinner ReservationsBronze* ($1,200) Bronze Page & 2 Dinner ReservationsEmerald** ($1,000) Full Page & 2 Dinner ReservationsAdditional Spouse Reservation ($150)Pearl (included as Staff Member) Half Page & 1 Dinner Reservations
Shulamith Faculty/Parent | Please select your desired registration/donation level*

Pillar Sponsor* ($100,000) Pillar Page & 10 Dinner ReservationsCorporate Sponsor* ($75,000) Corporate Sponsor Page & 10 Dinner ReservationsBenefactor* ($50,000) Benefactor Page & 10 Dinner ReservationsGuardian* ($36,000) Guardian Page & 8 Dinner ReservationsRegency* ($25,000) Regency Page & 8 Dinner ReservationsChai* ($18,000) Chai Page & 6 Dinner ReservationsPatron* ($10,000) Patron Page & 6 Dinner ReservationsDiamond* ($5,000) Diamond Page & 4 Dinner ReservationsPlatinum* ($3,600) Platinum Page & 4 Dinner ReservationsGold* ($2,500) Gold Page & 4 Dinner ReservationsSilver* ($1,800) Silver Page & 2 Dinner ReservationsBronze* ($1,200) Bronze Page & 2 Dinner ReservationsEmerald** ($1,000) Full Page & 2 Dinner ReservationsPearl ($375) Half Page & 2 Dinner Reservations
Deduct my prepaid Shulamith Faculty/Parent dinner obligation
General Registration | Please select your desired registration/donation level*

Pillar Sponsor* ($100,000) Pillar Page & 10 Dinner ReservationsCorporate Sponsor* ($75,000) Corporate Sponsor Page & 10 Dinner ReservationsBenefactor* ($50,000) Benefactor Page & 10 Dinner ReservationsGuardian* ($36,000) Guardian Page & 8 Dinner ReservationsRegency* ($25,000) Regency Page & 8 Dinner ReservationsChai* ($18,000) Chai Page & 6 Dinner ReservationsPatron* ($10,000) Patron Page & 6 Dinner ReservationsDiamond* ($5,000) Diamond Page & 4 Dinner ReservationsPlatinum* ($3,600) Platinum Page & 4 Dinner ReservationsGold* ($2,500) Gold Page & 4 Dinner ReservationsSilver* ($1,800) Silver Page & 2 Dinner ReservationsBronze* ($1,200) Bronze Page & 2 Dinner ReservationsEmerald** ($1,000) Full Page & 2 Dinner ReservationsPearl ($750) Half Page & 2 Dinner ReservationsSponsor ($500) Quarter PageSupporter ($375) ListingGreeting ($180) Listing
If you would like to change your reservation or add an additional donation, please include the details below along with the best way to reach you*
ALUMNI*

Alumni Dinner Reservation
What year did you graduate SHS?*
Who are you giving your donation in honor of?

Dr. Eric and Mrs. Sara Pollak, Guests of HonorMrs. Naomi Munk, Educator of the YearRabbi Moshe Zwick z"l, Special Memorial TributeCelebrating 10 Years of Shulamith High SchoolAll of the HonoreesOther
Would you like to include text for your ad?*
Please include your ad text in this box:*
How would you like your name to appear in the Scroll of Honor?*
How would you like your name to appear in the listing?*
Will you be attending the dinner?*

YesNo
Total number of guests in your party (Max 1)*
(Total including you)
Total number of guests in your party (Max 2)*
(Total including you)
Total number of guests in your party (Max 4)*
(Total including you)
Total number of guests in your party (Max 6)*
(Total including you)
Total number of guests in your party (Max 8)*
(Total including you)
Total number of guests in your party (Max 10)*
(Total including you)
Do you have a promo code?*
Promo Code
Please insert your promo code here if you have one.
Discount
How will you be paying for your registration?*

ACHCredit CardPayment will be sent though my donor advised fundCheck
Please select your donor advised fund below:*
Shulamith Institute for Girls, Tax Exempt ID 11-1686380
Would you like to add 3.50% to cover credit card fees for this transaction?*

Yes, add 3.50% to my totalNo
Would you like to add 3.50% to cover credit card fees for this transaction?*

Yes, add 3.50% to my totalNo
Someone from the Shulamith office will contact you regarding your payment details
If you would like to give a larger donation or inquire about placing a group ad for one of the honorees, please contact the office at (516) 564-1500 x114.
Subtotal
Total Due

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USDTotal Due at Checkout
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Registration Form

Registration & Donation Levels

Someone from the Shulamith office will contact you regarding your payment details