THE IRVING AND IRENE FRISHMAN MEMORIAL WALL
THE BOAS FAMILY MEMORY WALL 

MEMBER INFORMATION
First name    Last name
Address   City, State, Zip
Phone   Email
 
DEDICATION OPPORTUNITIES

• I would like to dedicate  plaque/s at $500 per name/plaque
 I would like to dedicate/donate for the Holocaust Memorial Plaque

 
PAYMENT OPTIONS

 My check is in the mail
 My credit card will be charged once, upon completion of the form below, in the amount of $500
 Please charge this amount for the
Holocaust Memorial Plaque. I will donate a minimum of (but not limited to) $36 to honor the Jews who passed away during the Holocaust.

 
PLEASE FILL OUT THE CREDIT CARD INFORMATION BELOW
Name on card   Charge Amnt.
Card Number   Card Type  
 
Exp. Date
    CVV Code  
 

 3 digits on back of card