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Special Campaign Form

Special Campaign Form

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- Special Monthly Contribution Campaign -

Click here for more about this campaign


At this difficult economic time, please participate in this critical campaign. Every individual, and every donation, counts.

I am happy to participate in this important campaign.
Please accept my contribution of: $
  US, to The Peltz Center for Jewish Life. 
 

 This contribution will be charged monthly for 12 months. (You may cancel at any time)
 


* Denotes required field

Title*
First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State
Post Code*
Country*
Phone
This is my home business address.

 

Card Type*
Card Number*
Expiration Date*
CVV Security Code



 

Acknowledgement
Email Address*
Reconfirm Email Address*
You may acknowledge my gift to my email address
Please acknowledge my gift by mail to the above street address.
 
Please contact me to discuss additional giving opportunities.
 



 

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Please wait a few seconds for acknowledgement online that your information was received.

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