PLEASE PRINT THE FORM BELOW AND MAIL IT WITH YOUR CHECK TO: 

TEMPLE ISRAEL 
140 CENTRAL AVENUE 
LAWRENCE, NEW YORK  11559 
……………………………………………………………………………………………………….

Temple Israel Contributions

CONTRIBUTION TO ________________________________________ FUND
                         
TO WHOM IS THE CONTRIBUTION BEING SENT TO ___________________________________

ADDRESS OF PERSON RECEIVING THE CONTRIBUTION ________________________________

IN HONOR OF ___________________________________ 
ON THE OCCASION OF __________________________  (name)                                                  

IN MEMORY OF _________________________________________________   


FROM WHOM IS THE CONTRIBUTION  ___________________________________________


ADDRESS ______________________________________


AMOUNT ENCLOSED ______________________________________