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		If Other, describe
		** Name	**Amount $ .

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

Describe other

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


- Make a selection - Allen Stone Library B'yachad Capital Campaign B'yachad Endowment Cantor Yaron Music Enrichment & Choir Early Childhood Center Flower Library Mitzvah Corps POWTY Prayerbooks/Torah Rabbis' Discretionary Religious school Silverstein Endowment Temple Tzedakah/Social Action 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 call 516-883-3144 ext 310 to make a donation. Please make checks
payable to: The Community Synagogue, 160 Middle Neck Road, Port Washington, NY 11050