Yom Hashoah Donation and Memorial Book

Please complete this form no later than March 8, 2021.
 Yom Hashoah Commemoration  

Suggested donation $36, $72, $180, $360.
 
Amount of donation. (Don't use $ when entering amount)

Your Information:
First name
Last name
Email
Billing address
City
State
Zipcode
Phone

Memorial Book: To submit the name of a loved one in the memorial book, fill out the information in this section. 
Submission area for names of loved ones who perished in the Shoah to be included in the Memorial Book 2021
 Please include the names I submitted last year  Please include the names I have listed below
 I do not wish to submit names  

Victim Information (names)
Name(s) of Victim(s) AND their Last Residence AND Died at Location AND Perished Year. Please fill the box.
Name(s) of Victim(s) AND their Last Residence AND Died at Location AND Perished Year - additional box for more names (if needed).
Name(s) of Victim(s) AND their Last Residence AND Died at Location AND Perished Year - additional box for more names (if needed).

Payment Information: Please do not enter dashes or punctuation. Select Visa or MC.
Type of credit card
Name on card
Credit card number
Security Code
Expiration

We thank you for your participation and for your generosity.
You will receive a ZOOM link by email prior to the event. 

Your donation is tax deductible.  The JCC is a 501(c)(3); our tax ID number is
68-0381321. We will send you a tax receipt.
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