RAC Individual Participant

To participate in the Remember A Child program, be matched with a child Shoah victim, and receive a Scroll of Remembrance certificate for your bnai mitzvah, please complete the form below and submit it with your payment.

Submitted by*

First Last

Relationship*

Parent/Guardian

Teacher

Self

Email*

Name of Parent or Guardian if different from above

First Last

Email of Parent or Guardian

Bnai Mitzvah Information

Bnai Mitzvah First Name (and optional middle name)*

Bnai Mitzvah Last Name*

Hebrew Name*

First (and Middle) ben/bat/b

Celebration*

Bat Mitzvah

Bar Mitzvah

Other

For other, please specify bnai mitzvah, simchat mitzvah, b mitzvah or another choice

Mailing Address for certificate*

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

Synagogue/Temple Name

Date of Bnai Mitzvah*

Honoring the Memory of a Specific Child Victim

You are welcome to specify the hometown and/or country or origin of a child Holocaust victim. You also may provide information about a child Holocaust victim who was a member of your family or someone whom you would like to remember or honor at your bnai Mitzvah. Please enter his/her name, hometown, or country of origin.

First Last

Victim

Hometown Country

Upload a photo of the Holocaust victim (optional)

Max. file size: 32 MB.

Please specify a boy or girl victim and share any additional relevant information or comments and add any additional info about the Holocaust victim:

This field is hidden when viewing the form

[HIDDEN FIELD - IF I DELETE IT IT COULD ERASE DATA PREVIOUSLY ENTERED] Please share any additional relevant information or comments.

Please allow a minimum of ONE MONTH to research your information and prepare a certificate.

Your generous donation to The Generations After DC Remember A Child program enables us to continue the important work of remembering child victims of the Shoah. Program volunteers research multiple databases to identify an appropriate match and send links for continued research at home or in class, as well as create a beautiful certificate suitable for framing. We are able to continue the program and remember and honor child victims through the support of families and organizations like yours.

Additionally, after underwriting the expenses associated with running the RAC program, the remaining funds are channeled to support organizations that provide direct services to aging Holocaust survivors, including Blue Card.

Contributions for Remember A Child begin at $72 per certificate. Your donation of $120, $90, $72 or more is greatly appreciated.

If the $72 donation per participant presents a financial hardship, a scholarship is available to any participant for whom an $18 donation is made for his/her certificate. Please note the scholarship in the “Additional Comments” field or contact generationafterdc@gmail.com.

Hebrew schools, classes, or other organizations are welcome to participate in the Remember A Child program. For a group of 6 students, a minimum donation of $36 per student is required.

Generations After DC Inc. is a 501(c)3 tax-exempt organization, tax ID 521492115. Please consult a tax advisor to determine the deductibility of your contribution.

Donation Amount*

$120, $90, $72, $36 or more is appreciated. If the address for the certificate is located outside of the U.S. please consider adding an additional $15 to cover the cost of shipping.

I want to notify someone of my donation via email:

Name for Notification of Donation:

First Last

Email for Notification of Donation:

Billing Information

Billing Name*

First Last

Billing Address*

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

Billing Email*

Billing Phone*

Payment Information

Payment Method*

By credit card

By check

If you are paying by check, please print the email confirmation you will receive after submitting this form and enclose it with a check made payable to "The Generations After." Mail it to: The Generations After, P.O. Box 2121, Rockville, MD 20847.

______________________________________________________________

Your Transaction Fee

Yes, I wish to add the transaction fee so Generations After receives my full donation.

No, I do not wish to add the transaction fee. Generations After will cover the cost.

Transaction Fee Amount

Price: $0.00

Credit Card

Total