Shalom on the Range Donation Form

Donor Name:(*)
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Contact Person:(*)
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Address:(*)
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Telephone:(*)
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Email:(*)
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Cellphone:(*)
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Website:
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The donor pledges to donate to the Jewish Community Center the following:(*)
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Estimated Retail Value:(*)
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The donor understands that the donation shown above will be given away by the Jewish Community Center during its fundraising events. The donor authorizes the Jewish Community Center and its representatives to use, publish, or otherwise distribute the name(s) shown below for donor recognition purposes.
Name for Program Listing:(*)
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Additional Information (description and/or restrictions):
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Delivery Information:
Solicitor:
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Please choose a delivery method:(*)
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Trouble filling out this form? Contact Lori Weight, Development Manager, 801.581.0098 ext. 153 Or