Southeast Benefit Alternate Payment Form

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Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Cell Phone*

My gift will be made by:*

Donor Advised Fund
Check
Zelle
Stock Transfer
International Currency

Our Sharsheret TAX ID is 13-4198529

Your donation will help support Sharsheret's programs and services:*

Take advantage of Additional Benefits:
*With a donation of $5,000 and above, we welcome you to Sharsheret’s exclusive Jewel Circle. Learn more at Sharsheret.org/jewelcircle
All gifts of $1000 or more received before November 23, 2025 will be recognized in the program listing.
Contributions excluding the ticket value of $110 per person are tax deductible.

I am attending:*

Yes
No

Number of Attendees*

First Name of Attendee #1

Last Name of Attendee #1

First Name of Attendee #2

Last Name of Attendee #2

First Name of Attendee #3

Last Name of Attendee #3

First Name of Attendee #4

Last Name of Attendee #4

Additional Names of Attendees*

Please list my name in the program as (For gifts of $1000 or more):

My contribution is in honor of:

Guest of Honor, Dr. Jessica Baitner

My contribution is in honor of:

Maimonides Award Recipient, Dr. Starr Mautner

My contribution is in honor of:

Woman of Valor, Abby Brody

Sharsheret's Founder Rochelle Shoretz, A''H

My donation is in commemoration of the tenth yahrtzeit of Sharsheret Founder Rochelle Shoretz A”H.

Employer's Matching Gift & Legacy Giving Program

My gift will be matched by my employer’s matching gift program.
I am interested in learning more about Sharsheret’s Legacy Giving program.

Southeast Benefit Alternate Payment Form

Southeast Benefit 2025