Temple Beth Torah Donation Form

Amount:

Individual Fund Information

Temple Beth Torah General Fund Russell Gerechoff Memorial Fund David & Tessie Krivins Memorial Fund Paul Morris Liturgical Music Fund Rabbi's Discretionary Fund George Rosen Memorial Fund Kitchen Fund Siddur ($54 minimum)

Rabbi Jacob Friedman Scholorship Fund Harold A. Goldberg Memorial Disabilities Fund J. Henry Marton Memorial Scholorship Fund Harry & Sadie Steinberg Memorial Fund Susan Samuel Memorial Fund Schlisserman Memorial Scholarship Fund Garden Fund Bible ($72 minimum)

This donation is being made (i.e. In Honor of..., or In Memory Of...):

This donation is being made by:

Name:
Address:

Please check if you want this printed in the bulletin

I would like an acknowledgment sent to the following:

Name:
Address:

Small Leaf ($250)
Large Leaf ($500)
Apple ($1,000)
Boulder ($5,000)

Engrave the plaque as follows (i.e. In Honor of..., or In Memory Of...):

NO CHANGES TO TEXT WILL BE ALLOWED ONCE ORDER IS SENT TO FACTORY

Price: $250

Name of Deceased:

Date of Death (English):

Time of Death: Before sunsetAfter sunset

PLEASE ALLOW 8 WEEKS PRODUCTION TIME

Amount:

Contribution sent to:

Name:
Address:
City/State/Zip:

Your card will be represented as follows:

Please note card layout and typeface shown above may not exactly match actual printed card.