Memorial/Honoraria Order Form

Memorial/Honoraria order form
Yahrzeit plaque, Leaf and Brick on the Tree of Life
Complete the appropriate section, and mail the entire form with your check, made payable to Congregation Beth Hillel, to
Fred Nelson, 94 Mandell Road, Pine Bush, NY 12566
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Yahrzeit Name Plate: $200
Supply complete English name and complete English date, including the year. Supply Hebrew name and date, if known. We will translate name to Hebrew as well as calculate the Hebrew date for you. Cost $200.00, payable to Congregation Beth Hillel.

English name__________________________________________English date of death_____________________________________________

Hebrew name__________________________________________Hebrew date of death____________________________________________

Tree of Life Leaf: $72
Print desired inscription on the lines below.
_________________________________________
_________________________________________
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_________________________________________
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Tree of Life Brick: $144
Print desired inscription on the lines below.
_________________________________________
_________________________________________
_________________________________________
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