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Temple Akiba Yahrzeit Plaque Order
Please verify reCaptcha before submitting the form.
Thank you for your interest in ordering a Yahrzeit Plaque for a loved one.
Cost:
Temple Members - $750
Non Members - $1,000
Payment is due upon completion of this form and can be made by credit card, ACH, or check. To pay by ACH or check please make sure you are logged into your Temple Akiba ShulCloud account. If you need assistance with logging in please contact Rebecca Holzberg,
admin@templeakiba.net
or 310-398-5783.
*
First Name of Person Placing Order
*
Last Name of Person Placing Order
*
Email of Person Placing Order
*
Mobile Phone of Person Placing Order
*
Address of Person Placing Order
*
City
*
City
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Are you a Temple Akiba member?
Please Select One
Yes
No
By filling out this form you are authorizing Temple Akiba of Culver City, 5249 S. Sepulveda Blvd., Culver City, CA 90230, to supply and maintain permanently a Yahzeit Plaque(s) on their Memorial Boards in loving memory of the name(s) filled in below.
*
How many Yahrzeit Plaques do you need to order?
Please Select One
One Plaque
Two Plaques
Three Plaques
Four Plaques
Five Plaques
*
How many Yahrzeit Plaques do you need to order?
Please Select One
One Plaque
Two Plaques
Three Plaques
Four Plaques
Five Plaques
*
Deceased 1 Name (as it should read on the plaque)
*
Deceased Relationship to You
*
For dates, choose either option 1 or 2*
Please Select One
Option1 - Enligh Date of Death / Hebrew Date of Death
Option2 - English Date of Birth / English Date of Death
*
English Date of Birth
*
English Date of Death
Hebrew Date of Death
*
Please notify me of the Yahrzeit on the
Please Select One
English Date
Hebrew Date
Time of Death if Known
Please Select One
Before sunset
After sunset
*
Deceased 2 Name (as it should read on the plaque)
*
Deceased Relationship to You
*
For dates, choose either option 1 or 2*
Please Select One
Option1 - Enligh Date of Death / Hebrew Date of Death
Option2 - English Date of Birth / English Date of Death
*
English Date of Birth
*
English Date of Death
Hebrew Date of Death
*
Please notify me of the Yahrzeit on the
Please Select One
English Date
Hebrew Date
Time of Death if Known
Please Select One
Before sunset
After sunset
*
Deceased 3 Name (as it should read on the plaque)
*
Deceased Relationship to You
*
For dates, choose either option 1 or 2*
Please Select One
Option1 - Enligh Date of Death / Hebrew Date of Death
Option2 - English Date of Birth / English Date of Death
*
English Date of Birth
*
English Date of Death
Hebrew Date of Death
*
Please notify me of the Yahrzeit on the
Please Select One
English Date
Hebrew Date
Time of Death if Known
Please Select One
Before sunset
After sunset
*
Deceased 4 Name (as it should read on the plaque)
*
Deceased Relationship to You
*
For dates, choose either option 1 or 2*
Please Select One
Option1 - Enligh Date of Death / Hebrew Date of Death
Option2 - English Date of Birth / English Date of Death
*
English Date of Birth
*
English Date of Death
Hebrew Date of Death
*
Please notify me of the Yahrzeit on the
Please Select One
English Date
Hebrew Date
Time of Death if Known
Please Select One
Before sunset
After sunset
*
Deceased 5 Name (as it should read on the plaque)
*
Deceased Relationship to You
*
For dates, choose either option 1 or 2*
Please Select One
Option1 - Enligh Date of Death / Hebrew Date of Death
Option2 - English Date of Birth / English Date of Death
*
English Date of Birth
*
English Date of Death
Hebrew Date of Death
*
Please notify me of the Yahrzeit on the
Please Select One
English Date
Hebrew Date
Time of Death if Known
Please Select One
Before sunset
After sunset
Total Amount Due
Sun, December 22 2024
21 Kislev 5785
Today's Calendar
Erev Tishah B'Av
Friday Night
Candle Lighting
: 7:20pm
Shabbat Day
Havdalah
: 8:27pm
This week's Torah portion is
Parashat Va-et'chanan
Shabbat, Aug 17
Candle Lighting
Friday, Aug 16, 7:20pm
Havdalah
Motzei Shabbat, Aug 17, 8:27pm
Erev Tishah B'Av
Monday, Aug 12
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Sun, December 22 2024 21 Kislev 5785
