Memorial Plaque Form

Date: ___________

Name of Subscriber: __________________________

Address : ____________________________________

          ____________________________________ 

Telephone Number: __________________________

Email Addresss: _____________________________

Information for plaque:

English name of Deceased: ________________________________________

Hebrew name of Deceased: _________________________________________


English date of death: ______________________________________

Hebrew date of death: _______________________________________


Cost of Plaque:  $600/name (one name per plaque)

__ Payment Enclosed      __ Please bill me

The new memorial wall will also include all 700 names that appeared on the memorial boards in the shul's old building. If you wish to obtain the original bronze plaque that was recovered after the fire in 1994, please email the shul office or phone 617-734-0276. If you have any questions, contact Kenny Wintman at 617-566-2483 or email him at kiw2020@msn.com