Name __________________________________________________ 

Home Address ___________________________________________ 

City ________________________________ State ____ Zip __________ 

Home Phone ________________ Cell Phone _______________________ 

Email ______________________________ 

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

Of _____________________________________________ 

If this is a contribution for a Mishkan T’filah prayer book or a Plaut Torah Commentary (minimum of $50) 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.​

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