The JRCC S Richmond Hill PURIM GIFT Participation Form Full Name First Name Last Name E-mail Phone Number Area Code Phone Number Mishloach Manot Options:** Please send to ALL 58 families from JRCC Richmond Hill - $180 Please send to ALL families from JRCC Rockford - additional $50 Please send to ALL families from JRCC West Thornhill - additional $50 Please send to ALL families from JRCC East Thornhill - additional $50 Please send to ALL families from JRCC South Thornhill - additional $50 Please send to specific families as specified below - $8/family I would like to send Mishloch Manot to the following families: $8/family Mr and Mrs David Aaron Mr and Mrs Adam Agiviev Mr and Mrs Oleg Amurjuev Mr and Mrs Shmuel Amurjuev Mr Misha Basin Mr and Mrs Robert Benchetrit Mr and Mrs David Bouhadana Mr and Mrs Alex Chaplik Mr and Mrs Vlad Chek Mr and Mrs Eli Cohen Mr and Mrs Pinchas Cohen Mr and Mrs Roman Dobkin Mr and Mrs Sergey Dondish Mrs. Nina Gaisinger Mr and Mrs Jim Goren Dr and Mrs Jerome Green Mr and Mrs Shachar Kalgal Mr and Mrs Kirill Kanevsky Mr and Mrs Boris Kartuz Mr and Mrs Oleg Khait Mr and Mrs Michael Khozin Mr and Mrs Stan Kompaniyets Mr and Mrs Eddie Kotler Mr and Mrs Leonid Liansky Mr Alex Makalski Mr and Mrs Yuri Polansky Mr and Mrs Boris Rozinov Mr and Mrs Alex Rudenberg Mr and Mrs Anthony Sacks Mr Eli Schwarz Mr and Mrs Yehudah Shemesh Mr and Mrs Alex Simkovitch Mr and Mrs Gadi Stepanski Mr and Mrs Peter Stroyev Mr and Mrs Chaim Suissa Mr and Mrs Jeff Szenes Mr and Mrs Roberto Tito Mr and Mrs Paul Tonkonog Mr and Mrs Alex Transky Mr and Mrs Mike Tulman Mr and Mrs Alex Vatmahter Mr and Mrs Yevgeny Vishnever Mr and Mrs Felix Winstok Rabbi and Mrs Avrohom Zaltzman Rabbi and Mrs Yoseph Zaltzman Mrs Julia Zaretsky Mr and Mrs Shimshon Zerdiker Mr and Mrs Sergei Zilbergerts Mr and Mrs Felix Zilnik Mr and Mrs Garry Zonis Mr. and Mrs. Allan Aginsky Mr. and Mrs. Eli Goldman Mr. and Mrs. Michael German Mr. and Mrs. Roman Klimtchouk Mr. Felix Margulis Mr. and Mrs. Tomer Ohayon Mr. and Mrs. Zvi Zemel Mr. and Mrs. Sam Winitsky You may choose single names from other JRCC branches: Click on the name of the branch to see its list, and write the names below. Rockford West Thornhill East Thornhill South Thornhill Use this box to add names from other branches: Total amount of names added from other branches: Total (Note: Tax receipts available for donations of $40 or more) $0.00 Payment Credit Card Cash or Check Credit Card Visa MasterCard American Express Credit Card Type Credit Card Number 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Expiration Year Submit Should be Empty: This page uses TLS encryption to keep your data secure.