Donation Form
Name
*
First Name
Last Name
Spouse Name (If Applicable)
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
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example@example.com
Spouse Email (if applicable)
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Contribution
Donation Amount
*
$54 (Member)
$101 (Contributor)
$180 (Supporter)
$360 (Benefactor)
$500 (Patron)
$1,000 (Underwriter)
$1,800 (Chai Underwriter)
$3,600 (Double Chai Underwriter)
Other Amount
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Description
Additional Information
Donation Type
*
Membership Renewal
New Membership
R1 Visa Program
General Contribution
Sale Of Chometz
Jeri Goldberg Finkelstein Kashruth Fund
Digital Membership Card?
*
Yes
No (Please send card in the mail)
Please add me to your email list for communication
*
Yes
No
Would you prefer to have your name included in our annual membership listing?
*
Yes
No (List it as "anonymous" )
Please provide your name as you would like it to appear in our newsletter
Synagogue Affiliation
*
Please enter the synagogue you are affiliated with. Please list as many that apply.
Memo
Please enter any description, in honor of, or notes about your donation
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