PJ Library Grandparent book request
Request a bag of Jewish books that your grandchildren can enjoy when visiting your home!
Participant Information
Pronouns
Please select...
She/her
He/him
They/them
No pronouns, just my name
Other
Please specify
First Name
Last Name
Why are we asking for pronouns?
https://urj.org/quick-guide-pronouns
Email Address
Phone number
Are you a member at Holy Blossom Temple?
Yes
No
Please list your grandchildren's ages below:
Please list any topic or theme requests below - i.e. Jewish Holidays, mitzvot, torah stories, family/Jewish identity, Israel, other
Are you affiliated with another congregation?
Yes
No
Congregation Name
Please send me information about membership at Holy Blossom Temple
I would like to make a contribution to the Literary Programming at
Holy Blossom Temple
Contribution Details
Total Contribution
$
Please help us to offset credit card processing fees by contributing an additional 3%
Yes
No
Adjusted Total
3% Fee
$
Total Contribution
$
Please list your name(s) as you would like them to appear in the Temple Bulletin or write ‘anon’ if the gift is anonymous.
Credit Card Information
First Name
Last Name
Billing Address
Billing City
Billing Province
Please select...
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Billing Postal Code
Billing address must match the address associated with the credit card.
Credit Card Number
Visa or Mastercard
Expiry Month
Please select...
1
2
3
4
5
6
7
8
9
10
11
12
Expiry Year
Please select...
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
Tax Receipting
All donations will be tax receipted in February of the following year by email
Tax receipts will be issued for donations of $18 or more
Invoice Name
Authnet_Hidden_Fields
Invoice req'd
Yes
No
Final Contribution
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Contact Information
