Please fill out the form below and return it to Stanley Rowen. Please refer to the Membership list for his address and phone, or e-mail chevreitzedek@gmail.com to contact him. If you'd prefer to complete this on line and submit it electronically, please go to https://spreadsheets.google.com/viewform?formkey=dG9DQ1AyLWFleVV4RWFhZFpKRWNkMHc6MQ.
Congregant’s Name___________________________________________
Preferred Notification (e-mail or post card; please provide e-mail or street address)
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RELATIONSHIP & TO WHOM |
DATE OF DEATH
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