In Honor of: ___________________________
Relation : ___________________________
Honoree's Address : _______________________ (If you want a card to be sent )
_______________________
Print this form, fill in and return to the
Inscription: _______________________________ Temple : Conregation Shalom Aleichem
________________________________ P.O. Box 422275
In Memory of : _____________________________ Kissimmee, FL 34742
Donated by: _____________________________
Phone: _____________________
Address: ________________________ City/State/Zip ___________________________