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.