Dedication Form

DEDICATION FORM

We are honored that you have chosen the HaKol to remember and celebrate your loved ones.

We ask that you please complete and return this form to the Office either by email at jewishmodesto@gmail.com, or by postal mail to Congregation Beth Shalom PO Box 85, Modesto, CA 95353.
The donation amounts are as follows:*

$18 up to 25 words$36 up to 25 words & photoOther
We have several payment options. Payments can be processed using Beth Shalom's ShulCloud Online Payment (click on the blue link to be directed to payment site) online system or by postal mail. Please include this form when sending your check to postal mail.
Donations can be made to two congregational funds:*

General Fund - This Fund is unrestricted and can be used for any expense incurred by the Congregation.Rabbi Discretionary Fund- This Fund is used at the Rabbi's discretion to support emergency needs in the coummunity and for special events and expenses.
When sending a check, please print and include this form, indicate the fund on the check, and mail to PO Box 85 Modesto, CA 95353.
Please check which method of donation you would like to make:*

MMontheWeb (click on the blue "MMontheWeb" link above to donate)Mail Check to PO Box 85 Modesto, CA 95353
Thank you for strengthening our coummunity!
Your Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Dedication Recipient's Name

First NameLast Name
Please choose a Dedication:*

In memory of...In honor of ...BirthdayWeddingBaby NamingGraduationYahrtzeitR'fuah shlemahSpecial EventSpecial Achievement
Please write your Dedication here:*
If this is for an event, please indicate the date:

MonthDayYear
Date
If you would like to add a photo, please upload photo here:

Browse Files

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If you would like to have your Dedication published in more than one HaKol Issue please indicate the number of issues you would like your Dedication to be published: ( ex. 1,2,3, 4....)
Thank you very much for submitting your Dedication. We will contact you shortly to confirm the Dedication.
Should be Empty: