Remember Us - Name Request or Registration Form

Contact
Information

Remember Us Project

2777 Yulupa Avenue, #273
Santa Rosa, CA 95405

Contact:
Elly Cohen,
Project Administrator
415-265-9801
E-mail: info@remember-us.org

Name Request or Registration Form

This form can be used to request a name of a lost child to remember or to register a name that you have already received from your synagogue, clergy, educator or tutor.

For new requests, you will receive an email confirmation within one week of receipt.

There is no charge to participate. Voluntary donations sustain and continue Remember Us. A suggested donation of $54 enables us to bring the Remember Us opportunity to another child, and to continue our outreach to help build a culture of Jewish memory. Please click here to donate.

Please feel free to contact us for more information.

info@remember-us.org

2777 Yulupa Avenue #273, Santa Rosa, CA 95405, 707-570-2883

Paula Simon, Executive Director paula@remember-us.org

Elly Cohen, Project Administrator elly@remember-us.org

*We would like to: Request a name to remember: Boy Girl

Register a name already received: Name:

*Full name of the bar/bat mitzvah:

*Date of the bar/bat mitzvah:

*How did you hear about us?:

*Name and address of your synagogue:

*Congregation affiliation:

*Name of the Rabbi or Cantor the bar/bat mitzvah student is studying with:

Email address for Rabbi or Cantor:

Your contact information:
*Name:
*Relationship to Bar/Bat Mitzvah:
*Mailing Address:
*City:
*State:
*Zip:
*Phone:
*Email:
Special Requests (Please indicate if you have any specific preferences for a name – by country of origin, first or last name, etc)

*required fields

ContactInformation

Remember Us Project

Name Request or Registration Form

Contact
Information