Making contribution for:
(Enter name and contribution amount)

Items with ** require an entry

- Make a selection - In honor of In memory of In appreciation of Speedy recovery to Marking the yahrzeit of Other ** Name	**Amount $ .
If Other, describe ...

For the occasion of
(Select an occasion or write your own)

- Make a selection - Anniversary Bar Mitzvah Bat Mitzvah Birth Condolences Speedy Recovery Wedding Engagement Yahrzeit Other

Describe other

Synagogue Funds
(Select a fund to apply your contribution to)


- Make a selection - Cantor Yaron Music Enrichment & Choir Capital campaign Early childhood center Flower Grounds beautification Havurat Noar Library Mitzvah Corps Prayer books Rabbis' discretionary Religious school Temple Temple (Torah Restoration) Tzedakah Rabbi Martin Rozenberg Discretionary Silverstein Endowment Wurzel Endowment
If you selected Prayer Books:
($50 inscribed prayer book/ $100 Torah inscribed)
Enter the date of the inscription below. Otherwise
leave the box immediately below blank.

Contact Information

	Send acknowledgment to			Donated by
**Name			Name
**Address1			Address1
Address2			Address2
**City			City
**State			State
**Zip			Zip
e-mail

If you are a member of The Community Synagogue, to make a donation please push the Submit
button and your account will be billed. You may also call or send your donation.



Nonmembers, please print this form or or call 516-883-3144 ext 110 to make a donation. Please make checks
payable to: The Community Synagogue, 160 Middle Neck Road, Port Washington, NY 11050