Full NameFirst NameLast NamePhone NumberArea CodePhone NumberE-mailI would like to receive news and updates by emailAddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryInclusive Item(s) DedicatedRevolution Inclusive Spinner - $36,000Tot Builders Playhouse - $36,000Accelerator Swing - $36,000Transfer Station with Safety Rails - $10,000Funhouse Activity Panel - $3,600Four-The-Win Activity Panel - $3,600Gear Play Panel - $3,600Seat Panel - $1,800Other Item(s) DedicatedPour N Place Surfacing - $100,000Grand Strand - $90,000NU-Edge 26' Tower - $50,000Revolution Inclusive Spinner - $36,000Tower Tunnel Slide - $36,000NU-Edge Tower Diamond Climber 1 - $18,000NU-Edge Tower Diamond Climber 2 - $18,000NU-Edge Rock Wall - $18,000Dragonfly - $18,000Hypersonic Slide - $10,000Pod Climber - $7,200Arched Bridge - $5,400Double Kids Slide - $5,400Double Ring Trek - $5,400Park Bench 1 - $5,000Park Bench 2 - $5,000Park Bench 3 - $5,000Solo Spinner - $3,600Stand-'N-Spin - $3,600Pogo Pod 1 - $1,800Pogo Pod 2 - $1,800Culvert Climber - $1,800Stepping Stones 1 - $1,000Stepping Stones 2 - $1,000Stepping Stones 3 - $1,000Hand Sanitizing Station - $1,000Rung Ladder - $1,000PaymentCredit Card Cheque, Cash or E-Transfer Credit CardVisaMasterCardAmerican ExpressCredit Card TypeCredit Card NumberName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearCheques are to be made payable to Chabad Lubavitch of Alberta Etransfer to [email protected]We will contact you to confirm dedication text for plaque.SubmitShould be Empty: This page uses TLS encryption to keep your data secure.