Tefillin Request Form

Yes! I'd like to bind myself to G-d and the traditions of my Jewish fathers. Please sendme a pair of Tefillin.

First Name:

Last Name:

Address:

City:

Postal Code:

Phone:

Email:

Rabbi:

Right Handed?

Left Handed?

I, (please print full name)

hereby affirm my commitment to don Tefillin each and every weekday as stipulated bythe laws and traditions, faith and spirit of Judaism.

I will give towards the cost of the Tefillin. (suggested payment $100)

Signed (your signature) Attest (Rabbi's signature)

Date

For office use onlyID: Paid: $ Tefillin given on:

A P R O J E C T O F T H E J E W I S H R U S S I A N C O M M U N I T Y C E N T E R O F O N T A R I O

5987 Bathurst Street, Suite #3, Toronto, ON, M2R 1Z3Tel. 416-222-7105 Fax. 416-222-7812 Email: jrcc@jrcc.org Website: www.jrcc.org

Approved by:

In memory of Eliyahu Ben Aba OB"M