Memorial Wall - The Chai Center

Ordering Your Plaque for the Memorial Wall
You may use this form to order a Memorial Plaque for a loved one.
The plaque will be custom engraved and placed on The Chai Center's Memorial Wall, where it will be be illuminated during the week of the yahrtzeit.
Price per plaque is $520 payable by credit card or check. Checks should be made to The Chai Center.
Please allow two to four weeks for engraving.
My Name*
First Name Last Name
E-mail*
Phone*

Area Code Phone Number
Name of loved one being memorialized*
First Name Last Name
Relationship*
Plaque should read as follows: Please limit to 3 lines
Line 1:*
Line 2:
Line 3:
Payment Options*

Memorial Plaque / $520
Total

$0.00

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Thank you for your payment. 100% of the proceeds of this donation or payment benefit The Chai Center, Inc.
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