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plaques
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BEACH HEBREW INSTITUTE

(Beach Synagogue)
109 Kenilworth Avenue, Toronto, Ontario M4L 3S4
416-694-7942 • info@beachhebrewinstitute.ca

M E M O R I A L   P L A Q U E   O R D E R   F O R M
Payment due in advance - $180.00 per plaque
Please make cheque payable to Beach Hebrew Institute
Amount enclosed: $

Member responsible for payment
Name:
Address:
Tel:
Email (optional):
Person to be commemorated:
Hebrew Name:
English Name:
Hebrew Date of Death:
Civil Date of Death:

A plaque may be reserved for a payment of $20.00 which will be applied against actual cost at time of activation

A tax receipt will be issued for difference between actual cost of plaque and amount paid.