Remember Us - Participating Congregation Program Material Request

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.

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

Please provide your contact information.

*Name:
*Title:
*Congregation/School:
*Address:
*City:
*State:		*Zip:
*Email:		*Phone:

Please send Memorial sheets and registration information for this year:
Quantity Requested:
# Boys:	# Girls:

Please send information for bnai mitzah families to request a name online:
Quantity Requested:

Special Requests / Needs:

*required fields