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Contact Information
Name
*
Prefix
First Name
Last Name
Suffix
Spouse
Prefix
First Name
Last Name
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Address
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Address Line 1
Address Line 2
City
City
State
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ZIP/Postal Code
Country
Home Phone
Cell Phone
for individual listed above in "name"
Email
*
email for individual listed in "name" above
If you are an alum, please enter the year you graduated and maiden name (if applicable)
Gift Description
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General Donation
Parnes Hayom ($180) / Mishmar Donation ($360)
Guest Lecture ($500)
Memorial Donation
Covid Relief
Annual Dinner
Capital Campaign
Other
Gift Amount
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$1,800
$1,000
$500
$360
$250
$180
$
Is this donation in honor/memory of a special occasion?
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If sponsoring a Parnas Hayom or Mishmar, what date would you like to sponsor?
Payment
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