Use this form to help The Friends of Jewish Dokshitsy save our history

I will help save our Jewish heritage with a gift of:
o  $100      o  $250      o  $500      o  $1000    o  $ ____other

Name_________________________________________________________________
Address_______________________________________________________________
City ___________________ State ______ Zip/Post Code__________ Country_______
Phone: Home _______________________________ Work______________________
E-mail: _______________________________________________ o send trip information
May we list you as a contributor? o  Yes- Listing Preference ______________________  My donation is in memory o / honor o of ______________________________________ Send trip information? o
Mail a check with this form to     The Friends of Jewish Dokshitsy*
                                             43 Ames St
                                             SHARON, MA 02067
*For a tax-deductible donation make check payable to:
The United States Commission For the Preservation of America's Heritage Abroad
    Be sure to write Dokshitsy Project on the check.