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About The Shul Jewish Art Calendar

Calendar Dedication Form

Your Information
Full Name*

First Name Last Name
E-mail*
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Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number
Please make my selections the same as last year.

YesNo
Please include my family's birthdays/yahrzeits/anniversaries on the following level:
Please select which level:*

$36 Calendar Dedication - 1 Dedication Date$72 Calendar Dedication - 2 Dedication Dates$100 Family and Friends Package - 5 Dedication Dates$250 Sponsor a Camper for a Week - 5 Dedication Dates$500 Month of Education Sponsor - 5 Dedication Dates$1,000 Program Sponsor - 5 Dedication Dates$1,800 Holiday Event Sponsor - 5 Dedication Dates
Please specify which program: $500 Month of Education Sponsor
Please specify which program: $1,000 Program Sponsor
Please specify which program: $1,800 Holiday Event Sponsor
Notes:
Birthdays/Yahrzeits/Anniversaries
* Please type names exactly as you'd like them to appear.
* Please fill in as much as information as you can.
Additional opportunity:
Sign up yourself or your loved ones for the Jewish Birthday Club! Find out when your Jewish birthday falls this year and receive a special gift free of charge. Click here for more details.
Please convert my secular occasion to the corresponding Jewish Date on the Calendar.

YesNo
How many names?
* Years are not required but will assist us in determining your Hebrew birthday.
* Year and therefore your age will NOT be printed in the calendar.
Birthday/ Yahrzeit/ Anniversary 1
Other:
Name 1

First Name Last Name
Relationship 1
Date 1

Month Day Year
Notes:
Birthday/ Yahrzeit/ Anniversary 2
Other:
Name 2

First Name Last Name
Relationship 2
Date 2

Month Day Year
Notes:
Birthday/ Yahrzeit/ Anniversary 3
Other:
Name 3

First Name Last Name
Relationship 3
Date 3

Month Day Year
Notes:
Birthday/ Yahrzeit/ Anniversary 4
Other:
Name 4

First Name Last Name
Relationship 4
Date 4

Month Day Year
Notes:
Birthday/ Yahrzeit/ Anniversary 5
Other:
Name 5

First Name Last Name
Relationship 5
Date 5

Month Day Year
Notes:
Birthday/ Yahrzeit/ Anniversary 6
Other:
Name 6

First Name Last Name
Relationship 6
Date 6

Month Day Year
Notes:
Payment
Total

$0.00

Payment

Credit Card Zelle

Postal / Zip Code

Country

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