Class Adopt-a-Survivor Submission

Name*

First NameLast Name

Email

Confirmation Emailexample@example.com

Name*

Which grade(s) are the students in?*

Phone Number*

Email*

Confirmation Emailexample@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

When does your class meet? (please be specific in timing on days of the week, etc.)*

At what time would you like a survivor to speak to your class?*

How many students are in the class?*

Please provide us with a brief description of the course.*

Please provide us with a brief understanding of how much Holocaust knowledge the students have.*

The Holocaust Council appreciates your honorarium of $180 if virtual and $360 if in person. Please select from the formats below*

Virtual $180In person $360

Please select one of the payment methods below. An invoice will be provided*

CheckCredit Card (fees apply)

Please send a check for ${theHolocaust} payable to Jewish Federation of Greater MetroWest to:

Jewish Federation of Greater MetroWest NJ
Attn: Trish DiPette
901 Route 10, P.O. Box 929
Whippany, NJ 07981-0921

PaymentData

charge amount

cc fee

Total amount due

USDDescription

Your Information