DONATION REQUEST FORM
Date of Donation:
Send Acknowledgement To:
Name:
Address:
Donor/Contributed By:
Town
State
Zip Code
Name:
Address:
TYPE OF DONATION:
Town
State
Quantity
Siddur Sim Shalom
Chumash
Fund
Amount
($30)
($65)
Fund
Amount
Diane & Abner Blumberg (Youth Learning
Zip Code
Amount
Library
Experiences in Israel)
Harris Flax (Nursery School)
Gabel (Maintenance of Gabel Tapestry)
Jeffrey David Meyers (Youth Education Enrichmen)
Helen & Lester Milich (Religious School
Scholarships)
General
Szije & Irwin Gersten (Repairs to holy objects in
Shirley Pintel (General Purposes)
Rabbi’s Tzedakkah
Synagogue)
Ann Glass (General Purposes)
Clare Green Nursery School
Religious School
Cecile Roth Memorial (Traditional Minyan)
Bruce Salmon (General and Athletic Purposes)
Jack Sanders (Adult Education)
Max Findling Zmigrod Society (Religious
School Holocaust MuseumTrips)
Howard R. Herman
Alan Marc Shreiber (Religious School Scholarships)
(Religious School Scholarships)
Merle & Isadore Kenwood
Thaler Scholarship (Camp Ramah Scholarships)
(Youth Learning Experiences in Israel)
Bud Kessler (General Purposes)
Jeffrey Mark Yagoda (Adult Education)
Yahrzeit
Yizkor
Kiddush
Louis & Belle Kopf (Youth Learning Experiences in
Israel)
June & David Salzman Education
Enrichment Fund
Robert Lazerowitz (Youth Activities)
In Memory of
In Honor of
In Honor of Bar/
Bat Mitzvah of
Best Wishes for a complete & speedy recovery
Best wishes on your special birthday
Other:
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Donation taken by:
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Bookkeeper:
Paid:
Cash
______
Bill to:
Check No.
_______
Will send in check
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