Memorial Plaque Form

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A Memorial Wall has been set up at Chabad of Longmont.

Our sages tell us that the best memorial for a loved that has passed on is to donate Tzedaka (Charity) in their memory.  You can dedicate a plaque on the Memorial, which will bear the name and date of the passing of a loved one, with a $360 Tax-Deductible contribution.

*During the Yizkor Service the names on the Memorial Wall will be mentioned in prayer.

*The lights which are adjacent to each plaque will be lit on days when the Yizkor Service is recited and also during the Month of Yarzeit.

  

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Memorial Plaque Information: 

Sample of Information need for each name submitted.

Name : Walter Cohen
Hebrew Name and Father's Hebrew Name: Moshe ben Avrohom
Date of Passing: September 1, 1989
Hebrew Date if Known: 13 of Elul 5759

        * Calculate the Hebrew Date of Passing Here  
  
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Payment Information:
Top 3 bigger plaques are $1,000 each.
The memorial donation for each plaque is $360.
 

Please call Rabbi Borenstein if you would like to set up a payment plan. 

 
DONOR INFORMATION (individual ordering the plaque)
First name    State
Last name   Zip
Address   Email
City   Phone
 
DEDICATION PLAQUE
I would like to dedicate  plaque/s at $360 per name/plaque.
Please inscribe the following name on the memorial tablet:
PLAQUE #1   PLAQUE #2
Last Name   Last Name
First Name   First Name
Hebrew Name   Hebrew Name
Father's Hebrew Name   Father's Hebrew Name
Date of Passing
mm/dd/yy 		  Date of Passing
mm/dd/yy

NOTIFICATION DETAILS
Please send Yahrtzeit cards to the following people on the yahrtzeit:
Name   Full Address
Name   Full Address
 
PAYMENT DETAILS
(Alternatively you may print this form and mail with a check to Chabad of Longmont 1053 Neon Forest Circle Longmont, CO 80504.)
Name on card   Amount to be charged
Card Number   Card Type
Exp. Date     CVV Code  3 digits on back of card