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PERSONAL INFORMATION

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Country

Phone Number

Email Address

DONATION

Amount

I plan to... (choose one)

Give through my FederationMake a recommendation to my Donor Advised Fund Send a check to Jewish Agency for Israel – North American Section

Name of Federation

Name of institution holding the Fund

Please mail your check to:

Jewish Agency for Israel – North American Section
633 Third Avenue, 21st Floor
New York, NY 10017