5771-
Sept. 2010 - Sept. 2011
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First Name |
Family Name |
Spouse’s Name |
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Address |
City |
Prov/St |
Post/ZIP |
Country |
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(
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(
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Daytime Phone |
Evening Phone |
E-mail Address |
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Membership Application and Donations |
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Qty |
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Total |
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Single
Membership |
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$120.00 |
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Family
Membership |
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$200.00 |
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Member High Holiday Ticket |
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$50.00 |
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Non-Member High Holiday Ticket |
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$75.00 |
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Memorial Plaque |
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$600.00 |
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General Donation |
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Restoration Fund |
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Cemetery Upkeep *** |
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$20.00 |
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*** For reserved burial plot
or family occupied plot |
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Meal |
Sponsor |
Date |
Occasion (in memory / honour of) |
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Shabbat
Kiddush |
$250.00 |
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Shabbat
Meal |
$350.00 |
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Weekday
Breakfast |
$50.00 |
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Weekday
Mincha |
$50.00 |
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Total Amount |
$ |
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Donations can also be made
through our website. www.theminsk.com
5771 - Sept. 2010 - Sept. 2011
ADDITIONAL iNFORMATION
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Hebrew Name |
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Spouse Hebrew Name |
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PARENTS’ Hebrew Names |
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SPOUSE’S PARENTS’ Hebrew Names |
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cHILDREN |
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nAME |
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HEBREW nAME |
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BIRTHDATE |
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FAMILY YAHRTZEIT INFORMATION |
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hEBREW nAME |
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yAHRTZEIT dATE |
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rELATIONSHIP |
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