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First Name: _______________________________________

Last Name: _______________________________________

Street Address:_______________________________________

City, State, Zip: _______________________________________

Email Address: _________________________________________

Other Household Members: (All people living in a single household are eligible to be household members.)

1. __________________________________ Email:________________________________

2. __________________________________ Email:________________________________

3. __________________________________ Email:________________________________

4. __________________________________ Email:________________________________


Please make checks payable to Brit Tzedek v'Shalom and mail it to
Brit Tzedek v'Shalom,
the Jewish Alliance for Justice and Peace
11 E. Adams, Suite 707
Chicago, IL 60603


Brit Tzedek v'Shalom, the Jewish Alliance for Justice and Peace - 11 E. Adams, Suite 707 - Chicago, IL 60603
Ph: (312) 341-1205 - Fax: (312) 341-1206 - info@btvshalom.org


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