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East European Jewish Heritage Project (USA) Ltd.
Please print and complete this page, and send it by mail with your
cheque or money order, payable to "East European Jewish Heritage Project" to:

EEJHP(USA) LTD 969 Placid Court Arnold, MD 21012-1527 USA

1.  About You
Name:  _______________________________________________

Street address:_________________________________________

City, State & Zip Code:_________________________________ 

Email Address:______________________________

Telephone number(Optional): __________________________

Total cheque amount: ___________________

2.   About your gift
I am contributing the following to the EEJHP

[    ]	$25
[    ]	$50
[    ]	$75
[    ]	$100
[    ]	Other_______

I would like my gift to be used  for the following:

Check all that apply General Community Renewal Welfare Education Preservation and Heritage Other: _________________

About your privacy
[   ]  I grant the EEJHP the right to publish my name and the city I live in in donor reports made available to the public on the Internet.

[   ]  I prefer to remain anonymous.  

Date:                                                         Signature:

 

Any Comments?:

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