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LitvakSIG Mail-In Contribution Form

If you are handwriting the information into the form, please make sure the information is legible. If including credit card information, please double check the account number and expiration date are accurate to avoid any delays in the processing of your contribution.

If you type the information into the form please double check the credit card information to ensure all the numbers are visible when the form is printed for mailing or faxing.

Don’t forget to sign the form if using a credit card. Thanks.

Please mail your contribution form to:
Eden Joachim
Treasurer
LitvakSIG
41 Country Club Lane
Pomona, NY 10970
USA.
Full Name:
Organization:
Address:
City:
State/Province:
Postal/Zip Code:
Country:
Telephone(Home):
Fax:
Email:
Please accept my contribution of $________ and apply as shown below:
District Research
District
Notes
Amount
Disna
Kaunas
Lida
Oshmiany
Panevezys
Raseiniai
Siauliai
Suwalki Gubernia
Svencionys
Telsiai
Trakai
Ukmerge (Vilkomir)
Vilnius (Vilna)
Zarasai (Novo-Aleksandrovsk)
General Research Fund
Special Projects and Dues
Apply Donation To
Notes
Amount
Vilnius Household Registers
Internal Passports - City of Vilnius
MACEVA Cemetery Project
Website / IT
Speaker's Fund
Administrative
Memorial Donation
Dues at $50 US for calendar year
General
If paying by Credit Card, please fill out the information below, sign and include with the information above.
Visa
Master Card
American Express
Discover Card
Card Number
Expiry Date
(mm/yy)
Total Amount to be Charged
Signature
Print Form