Please Print this page and send with your payment to:
Mayyim Hayyim, 1838 Washington Street, Newton MA 02466
Or fax with Credit Card Information to: 617-244-1830
Or Call with Credit Card Information: 617-244-1836 ext 202

__Yes! I would like to support the sacred work of Mayyim Hayyim!

__Gift in honor of* _____________________________________________
__Gift in memory of* ___________________________________________
__Mayyim Hayyim Immersion Gift Certificate for: ______________________
                                  amount: _____________________
Acknowledgement / Gift Certificate to be sent to:____________________
Address:__________________________________________________
(Mayyim Hayyim's President, Anita Diamant and Executive Director, Aliza Kline will send a personal note on your behalf to the individual(s) being honored or to a family member of the person memorialized by your gift. Please include Name, Address and Phone of person(s) to receive a personal note.)

INDIVIDUAL/FAMILY MEMBERSHIP
__Individual Membership $360
__Family Membership $500
__Individual Sustaining Membership $720
__Family Sustaining Membership $1,000
__Lifetime Individual Membership $25,000

INSTITUTIONAL/CONGREGATIONAL MEMBERSHIP
__Smaller Congregation Membership $250
__Medium Congregation Membership $500
__Large Congregation Membership $1,000
__Very Large Congregation Membership $1,500

Name of Congregation ______________________________
Congregational Liaison______________________________

Enclosed is a check for $__________made payable to Mayyim Hayyim. I prefer to charge $_________ to my credit card.
__Visa __MasterCard
Card Number:_____________________________________________
Security code/CW2 code (located on back of credit card) ____________
Exp. Date:__________
Signature:___________________________________________________
Name(s)____________________________________________________
Address____________________________________________________
City__________________________State_______Zip________________
Phone (H)________________Phone (W)___________________________
E-mail______________________________________________________

* Payment plans are available for any size contribution.
Mayyim Hayyim has been designated a 501(c)(3) agency. Gifts to Mayyim Hayyim are tax-deductible.

Please print this page and send with your payment to:
Mayyim Hayyim, 1838 Washington Street, Newton MA 02466
Or fax with Credit Card Information to: 617-244-1830
Or Call with Credit Card Information: 617-244-1836 ext 202