Memorial Plaque

Memorial Plaque Order Form
Temple Beth El prides itself in being a warm, friendly, and inviting house of worship, where our members are part of our family. To preserve the memory of a loved one, Memorial Plaques may be purchased and will be displayed during our Shabbat Services while remembering our loved one's Yahrzeit. The price for the Memorial Plaque is $300.
Person requesting Memorial Plaque

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Person being Memorialized (English)

First NameLast Name
Person being Memorialized (Hebrew)

First NameLast Name
Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Please have plaque engraved in: (check all that apply)*

Only EnglishOnly HebrewBoth - English & HebrewInclude date of death?
Will you be paying by cash or credit card?*

CashCredit Card
Please consider paying an additional $3.00 to cover the bank fees incurred when using a credit card

Yes, I will be happy to pay an additional $3.00 to cover the bank feesNo thank you, charge my credit card the original amount
The donation for a Memorial Plaque is $300. Please write "Memorial Plaque" in the memo part of the check and mail it to:

Temple Beth El

5150 Peridia Blvd. East

Bradenton, FL 3420

To pay by credit card, please complete the information below.

Memorial Plaque Order Form