Remember Us - Congregation / Institution Registration & Request Form

Samara Hutman
Executive Director
1112 Montana Avenue, #182
Santa Monica, CA 90403
310-656-2806
E-mail:
info@remember-us.org

Please feel free to contact us for more information.

1112 Montana Avenue #182, Santa Monica, CA 90403, 415-265-9801

Please provide your contact information.

*Name:
*Title:
*Congregation/Institution:
*Affiliation:
Website:
*Mailing Address:
*City:
*State:		*Zip:
*Phone:		*Email:

*Approximate Number of Bnai Mitzvah Per Year:

*How did you learn about Remember Us?

Please email the “Student Invitation for Congregations” form for us to print & distribute to B'nai Mitzvah families so they request a name from our website OR
Please send Memorial sheets and registration information for this year:
# Boys:	# Girls:

Special Requests / Needs:

*required fields