So that we can best respond to your inquiry about the committee, please take a moment to complete and submit the following survey or Click here to open a printer friendly Adobe Pdf to print and then fax us at (626)773-8825. Thank you!

1. My contact information:
Name:

Address:

Telephone:
Work: Home: Cell:
Fax:
Email:
* This is a required field

2. My connection to Bardejov:


:

3. Do you have relatives who are buried in the cemetery? If so, please identify them:
Grandparents
Hebrew Name
English Name
Date of Death
 
1.
 
2.
 
3.
 
4.
 

 


Parents
Hebrew Name
English Name
  Date of Death
 
1.
 
2.
 

 

Others

Hebrew Name
English Name
Relationship to you
  Date of Death
1.
2.
3.
4.
5.
6.

4. The best way to contact me is by (please select your first choice):




5. My interest in the Bardejov Jewish Preservation Committee (please check all that apply):
Joining the committee
Adding my name to the mailing list
Receiving information about the Bardejov Jewish Heritage Reunion
Trip
Other (please explain):

6. Other information about me:

To submit this survey, please click here.

Please do not send any money to the committee at this time
Bardejov Jewish Preservation Committee, 905 S. Fair Oaks Avenue, Pasadena, CA 91105, USA
Tel: (626)773-8801, Fax: (626) 773-8825, Email: info@bardejov.org