Donations Form

Name __________________________________________________ 

Home Address ___________________________________________ 

City ________________________________ State ____ Zip __________ 

Home Phone ________________ Cell Phone _______________________ 

Email ______________________________ 

This gift is in Honor/Memory/Celebration (please circle) of
_____________________________________________ 

For a contribution for a Torah Commentary (minimum $50) please check  ______ 

For a contribution to our Holocaust Education Fund, please check here ______

Please send acknowledgment card to:
_______________________________________________ 
_______________________________________________ 
_______________________________________________ ​

Checks should be made payable to: 

The Hebrew Congregation of Chautauqua

P.O. Box 555

Chautauqua, NY 14722 

GIFTS ARE TAX-DEDUCTIBLE TO THE EXTENT ALLOWED BY LAW.​