Donation Form – The Greening of Kibbutz Lotan

A minimum of 5$ per planting is requested.

I am making #________ planting(s). Enclosed is my check for: $______

In memory of/ In honor of/ Other:

Certificate should be signed as follows:

Mail certificate to the following address:

Make checks payable to: URJ Kibbutz Fund - 100% of the donation goes to Kibbutz Lotan

Mail to: Susan Cicelsky, 6 Westbank Rd., Rye, NY 10580

My e-mail address is: