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Thank you so much for your donation to Beth Chai!  Your donation can be applied to Beth Chai's General Fund or you can specify a request in the Comment section below.
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Donation

* Mandatory fields
 

Contact Information

*First Name
*Last Name
*Address
*City
*State
*Zip Code
*Email
Phone
Cell Phone
Spouse/Partner First Name
Spouse/Partner Last Name
Spouse/Partner Email Address
Alternate Email Address
*What Year Did You First Join Beth Chai?
*How many family members will belong to Beth Chai (Ex, 1, 2, etc.)
 

Children's Information (if applicable)

Number of Children
Child 1 First Name
Child 1 Last Name
Child 1 Birthdate (mm/dd/yy)
Child 1 Grade as of September of current year
Child 2 First Name
Child 2 Last Name
Child 2 Birthdate (mm/dd/yy)
Child 2 Grade as of September of current year
Child 3 First Name
Child 3 Last Name
Child 3 Birthdate (mm/dd/yy)
Child 3 Grade as of September of current year
Child 4 First Name
Child 4 Last Name
Child 4 Birthdate (mm/dd/yy)
Child 4 Grade as of September of current year
*Amount ($USD)
Address (donation)
City (donation)
State / province
Postal code
Country
Comment
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