Please complete the relevant fields in this form using your preferred information. Our system will be updated based on what you submit and will be used going forward.

How many adults live in the household?

If adult children live in your household, we ask that each adult child complete a separate form with their preferred information.

How many children under 18 live in the household?
Child information will be completed on page 2 if applicable.

Contact 1 Information

Salutation

First Name

Last Name

Preferred Name: i.e. Rob for Robert

Date of Birth

Gender Identity

Home Phone

Mobile Phone

Email

Secondary Email

Occupation

Contact 1 Additional Information

Preferred Method of Contact for Solicitation/Outreach

Preferred Phone Number for Solicitation/Outreach

I would like to receive text messages from the Buffalo Jewish Federation

Preferred way to receive Acknowledgements or Billing Statements:

Statement Cycle: Frequency you would like to receive your billing statement:

Annual Donor Honor Roll Listing

Please enter name exactly how you would like it to appear in the honor roll.

Synagogue affiliation if applicable?

To select more than one synagogue, press shift when selecting the names. It will highlight all selections.

My Jewish Buffalo

I do not currently receive My Jewish Buffalo, please add me to the email list

Adult Contact 2 Information

If there are no additional adults in your household, select Next Page to proceed.

Adult Contact 2

Salutation

First Name

Last Name

Preferred Name: i.e. Rob for Robert

Date of Birth

Gender Identity

Home Phone

Mobile Phone

Email

Secondary Email

Occupation

Adult Contact 2 Additional Information

Preferred Method of Contact for Solicitation/Outreach

Preferred Phone Number for Solicitation/Outreach

I would like to receive text messages from the Buffalo Jewish Federation

Preferred way to receive Acknowledgements or Billing Statements:

Statement Cycle: Frequency you would like to receive your billing statement:

Annual Donor Honor Roll Listing

Please enter name exactly how you would like it to appear in the honor roll:

i.e. Mr. Robert Smith or Bob Smith

Synagogue affiliation if applicable?

My Jewish Buffalo

Please add me to the My Jewish Buffalo email list

Household Information

Primary Household Address

Street Address

City

Country

State

Provinces

Postal Code

Do you have a winter residence or vacation home?

Secondary Address

Months at secondary address: i.e. December - April

Street Address

City

Country

State

Provinces

Postal Code

Household Information

Household Annual Donor Honor Roll Listing

Please enter name exactly how you would like it to appear in the honor roll:

Mr. Robert and Mrs. Susan Smith or Robert and Susan Smith

Household Formal Greeting:

i.e Mr. Robert and Mrs. Susan Smith

Household Informal Greeting:

i.e. Robert and Susan

Does your household currently receive the Jewish Journal

Children(s) Information

Child 1

First Name

Last Name

Date of Birth

Gender Identity

Grade

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

If your child is a teen, can the adult facilitator contact your child directly with program updates:

Mobile Phone

Email

Child 2

First Name

Last Name

Date of Birth

Gender Identity

Grade

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

If your child is a teen, can the adult facilitator contact your child directly with program updates:

Mobile Phone

Email

Child 3

First Name

Last Name

Date of Birth

Gender Identity

Grade

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

If your child is a teen, can the adult facilitator contact your child directly with program updates:

Mobile Phone

Email

Child 4

First Name

Last Name

Date of Birth

Gender Identity

Grade

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

If your child is a teen, can the adult facilitator contact your child directly with program updates:

Mobile Phone

Email

Child 5

First Name

Last Name

Date of Birth

Gender Identity

Grade

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

If your child is a teen, can the adult facilitator contact your child directly with program updates:

Mobile Phone

Email

Additional Child Information

Do you currently receive PJ Library Book?