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Memorial Plaque Order Form


One plaque may be ordered on each form. For any additional orders, please complete an additional order form.

Purchasers will be sent an email confirmation following the submission of each order. If changes are needed, please call the synagogue office at (502) 458-5359, as soon as possible.

CONTACT INFORMATION
 
 
  

PLAQUE INFORMATION

Please complete the information below. Use additional order forms for each plaque request.
 
(as it is to appear on the plaque)
 

TOTAL DUE
 
Thu, May 1 2025 3 Iyyar 5785