Yom Kippur Memorial Book, Wall & Bench Submission and Contribution Form

   

Please return your submission and contribution no later than August 28, 2017.

 

 Yom Kippur Memorial Book

                   
The Yom Kippur Memorial book will be available at the Yizkor service (4:30 p.m.) on Yom Kippur, Saturday, September 30, 2017.
                   

Yom Kippur Memorial Book Tribute Form

Please complete all sections below and PRINT clearly.

 

Suggested contribution levels are:

This is the first time I/we have submitted names for inclusion in the Book. Please include my tribute as detailed below.

   $36 $75 Other    

Reprint last year’s entry with NO changes.

  $100 $180      

Reprint last year’s entry WITH changes.

  Memorial Wall $1,000 Memorial Bench $5,000  
          You will be contacted to confirm your memorial plaque or bench plaque name(s)  
                   
         

Amount enclosed: $.

   
         

Make your tax-deductible check payable to Congregation Beth Israel.

To pay by credit card please see below.

 
                   

First time listing, OR changes to previous listing. Please place first name and last name of loved ones below:

         
1.  

Payment Information

2.    I will mail a Check or Money order payable to CBI
3.   Please charge my:
4.  

Card number:

5.  

Expiration Date:

6.  

Zip:

Remembered by:

     

Name on Card:

 Name:      

          

 Name:     

         

 Address:

         

 Phone: