To make a contribution, please print the following form
and mail with your check, payable to
"Routes to Roots Foundation, Inc."

The Miriam Weiner Routes to Roots Foundation, Inc.

73 Harbor Key, Secaucus, New Jersey 07094 USA
Tel: 201/866-4075; Fax: 201/864-9222

YES, I want to support the research and documentation
of Jewish roots in the archives of Eastern Europe


Name: ___________________________
Address: ___________________________
City: ___________________________
State: ___________________________
Postal Code: ___________________________
Country: ___________________________
$     500  Sponsor ___________________
$  1,000  Sustaining ___________________
$  2,500  Patron ___________________
$  5,000  Benefactor ___________________
$10,000  Guardian ___________________
$________ Other ___________________

The foundation is a Not-For-Profit Corporation
in accordance with section 501(c)(3) of the Internal Revenue Code
Registered in the States of New York and New Jersey


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