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Shul Partnership

Shul Partnership

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SECTION I:  YOUR INFO

 

SECTION II:  SPOUSE'S INFO

 Name

 

Name

 Hebrew Name    Hebrew Name
 Father's Hebrew 
 Name
   Father's Hebrew 
 Name
 Mother's Hebrew
 Name
  Mother's Hebrew
 Name
 Occupation    Occupation
 Birth Date /  /
MM / DD / YYYY format
   Birth Date /  /
MM / DD / YYYY format
 Jewish by:  Birth     Converted    Jewish by:   Birth      Converted
 Check One:  Cohen   Levi   Israel    Check One:   Cohen   Levi   Israel

SECTION III:  PERSONAL INFORMATION

Address   Email 1
 City/State/Zip   Email 2
 Home Phone   Marital Status
 Work Phone   Anniversary Date /  /
MM / DD / YYYY format
 Work Fax   If Divorced: If divorced, do you have a
Jewish "Get" ?  Yes   No

SECTION IV: CHILDREN

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

 Name

 

 Birth Date

/  /
MM / DD / YYYY format
 Are any children adopted?  Yes   No    If yes, give details, including any coversion info:
 

SECTION V: YAHRZEIT INFORMATION

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

 Name


English / Hebrew / Father's Hebrew / Last

 

/  /
Date of Passing: MM / DD / YYYY
Relationship

SECTION VI: PARTNERSHIP OPPORTUNITIES
Partnership Opportunities have been designed within a wide range.  All Partnership gifts can be made in one installment or in 12 monthly installments. Please check the option of your choice. 
Gold Partnership $500 Monthly - $6,000 Yearly
Double Chai Partnership $360 Monthly - $4,320 Yearly
Silver Partnership $300 Monthly - $3,600 Yearly
Chai Partnership $150 Monthly - $1,800 Yearly
Family Partnership $90  Monthly - $1,080 Yearly
Associate Partnership $54  Monthly - $648 Yearly

SECTION VII: PAYMENT INFORMATION

Payment Method:

 Credit Card
 Check is in the mail 
 
Optional Comments:
  Please charge my:  

I wish to pay the full annual donation
I wish to pay 12 Month Installments
You will be charged at the beggining of each month.
Begin payments on:

  Card Number:
  Exp. Date      CVV Code:
 
   

TOTALS: 

 

    Partnership Total Amount:

    Total Amount to be charged:



 


* All contributions are tax deductible.

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