Memorial Plaques Form - Beth Israel Congregation

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Remember A Loved One - Zachor

* Ordered by First Name

* Ordered by Last Name

* Address Line 1

Address Line 2

* City,

* State

* Zip Code

* Email

Primary Phone

Deceased’s English Name

Deceased’s Hebrew Name*

(Example: Issac, son of Abraham & Sarah)

English Date of Death

Before or After Sunset

Before SunsetAfter Sunset

Hebrew Date of Death*

Please check if you would like assistance determining these

YesNo

I would like to be present when the plaque will actually be installed, in addition to attending the dedication ceremony

YesNo

Please write a sentence about your loved one to be read at the plaque dedication on Selichot

Once plaques are installed, they are permanently affixed and cannot be moved. You may purchase the adjacent space for future memorial plaques. Please contact Ann Friedman in the synagogue office to discuss (afriedman@bethisrael-om.org)

I, the undersigned, request that a memorial plaque be ordered based on the above information.

Signature (Full Name)

Date

* I would like to pay today:

Total Paid Today

Wed, May 31 2023 11 Sivan 5783