Memorial Plaque Purchase Agreement Today's Date* MM slash DD slash YYYY Your Name* First Last Your Address* Street Address City State / Province / Region ZIP / Postal Code Your Email* Your Phone Number*I would like to purchase a bronze Memorial Plaque for:Name (as you would like it to appear on the Memorial Plaque):* Who was my (relationship):* Who passed away on (English date of death):* Before or after sundown:* before sundown after sundown I do not know Hebrew date of death (if you do not know this, please leave blank and GJC will fill this in for you): If you would like Germantown Jewish Centre to retain the family history of your loved one, please feel free to fill out the information below to the best of your knowledge. This section is optional.Parents' names: Name(s) of sibling(s):Spouse's name: Name(s) of child(ren), including in-laws:Name(s) of grandchild(ren):It is understood and agreed that the plaque will include the name, English date of death and the Hebrew date of death. The memorial light will be lit and the name will be read aloud on the week of the Jewish anniversary of death, and during Yizkor services throughout the year: Yom Kippur, Shemini Atzeret, Pesach and Shavuot. The name will also included in the “Perpetual Remembrance” section of the Book of Remembrance (Yizkor Memorial Book). I agree to pay Germantown Jewish Centre the sum of SIX HUNDRED DOLLARS ($600.00) with this agreement. The perpetual maintenance is the responsibility of Germantown Jewish Centre at no cost to the purchaser. It is understood that names, dates and times are the responsibility of the purchaser.I agree to purchase this Memorial Plaque:*$600Total $0.00 When you click submit, you will be taken to PayPal to purchase the Memorial Plaque. You do not have to have a PayPal account; you may opt to pay with a credit or debit card. Δ
