CONTACT INFORMATION
Torah Dedication Project
‫מ כון‬
THE NESHAMAH INSTITUTE
‫נש מ ה‬
The Neshamah Institute
GROWING JEWISH SOULS
Name ____________________________________________________________________________________________________________________________________________
Address __________________________________________________________________________________________________________________________________________
City/State/Zip ____________________________________________________________________________________________________________________________________
Phone ____________________________________________________________________________________________________________________________________________
Email ____________________________________________________________________________________________________________________________________________
DEDICATION GRAND TOTAL (from the back) $_____________
{ } Enclosed is my check made payable to The Neshamah Institute.
Please charge my:
{ } American Express { } Visa
{ } MasterCard
Cardholder Name _________________________________________________________________________________________
Card # ____________________________________________________________________________________________________
Exp. Date _______________ Billing Zip Code __________________ Validation Code
(3- or 4-digit number
on signature strip) _______________
Signature __________________________________________________________________________________________________
THE NESHAMAH INSTITUTE IS A REGISTERED 501C3 TAX EXEMPT ORGANIZATION. A RECEIPT FOR YOUR DONATION WILL BE ISSUED TO ALL DONORS.
Please mail this form to:
The Neshamah Institute
21845 Powerline Road,
Suite 205
Boca Raton, FL 33433
For more information,
please call 561.212.3336
or email rabbi@niboca.org.
Section of the
Torah
Torah Dedication
Sample
Shin
Price per
Quantity
Item
$18
Letter(s)
$18
Hebrew Name(s)
$50
Sentence(s)
$118
Chapter(s)
$350
Portion(s)
$500
Book(s)
$1000
1
Occasion
Item
Total
In honor of the birth of Shlomo
$18
DEDICATION GRAND TOTAL $_____________
Please list the donor name(s) as you would like it printed on the donor recognition materials: _____________________________________________________________________________
Thank You For Fulfilling This Mitzvah!