Cards and Tributes Request Form

Complete this form, print it out, and send — with your payment via check made payable to SHARONE HADASSAH — to Marlene Burak, 160 Newell Avenue, Los Gatos, CA 95030. [Note Change of Address]

I wish to send the following:

Hadassah Cards -- All Occasion for only $5.00. Select purpose below.

Assortment (6 for $18) Please Specify Which:
Birthday	Wedding	New Baby
Anniversary	Bar/Bat Mitzvah	Get Well
Mazal Tov	Thank You	Sympathy

Certificates -- $10, $18, $25, $36, $50, $100 to $1,000.

Youth Aliyah	HMO	Breast Cancer Research
Children's Pavilion	Other:
Amount	Occasion

JNF Trees -- Mininum Donation $18 per tree.

Amount	Occasion

In addition, there are opportunities to make major leadership gifts for special occasions.

Hadassah Associates -- Husbands, brothers, and sons can be identified with the vital work of Hadassah by becoming lifetime affiliates for a one-time gift of $300, which is invested in an endowment fund for research in Hadassah's medical programs.

Amount	Occasion

Keepers of the Gate -- Leadership giving program sets the standards for action-oriented philanthropy with emphasis on healing with an annual $1,000 commitment to HMO programs.

Amount	Occasion

Hadassah Yahrtzeit -- Sanctify the memory of a departed loved one in perpetuity in Israel for a one-time gift of $1,000. Kaddish is recited on the Yahrtzeit in the Abbell Synagogue of the Hadassah Hebrew Medical Center in Jerusalem. A certificate is issued to the person establishing the memorial.

Amount	In Memory Of:

(Please complete one form for each recipient)

Recipient's Information — Please send TO:

Name
Address
City State Zip Code

Sender's Information — Sent BY:

Name
Address
City State Zip Code
Telephone Email

Name as you wish it to read on the card/certificate:

Personal message to be added:

Do you want your return address to appear on the card and/or certificate?
Yes No

(Print out, enclose payment, and return as specified above.)