Please print, complete and mail us the following form:

The Pooled Fund for Jewish Community Activism on Gay, Lesbian, Bisexual and Transgender Issues Response Form Name _________________________________________ Phone ___________________________ Address ________________________________________________________________________ ______________________________________________ Email ___________________________ __ Yes, I want to offer the following advice, skills and support to organize resources for overcoming homophobia in Jewish life and supporting gay, lesbian and bisexual Jewish youth: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ __ Here are the names of other individuals and organizations who would be interested in receiving information about this project: Name _________________________________________ Phone ___________________________ Address ________________________________________________________________________ ______________________________________________ Email ___________________________ Name _________________________________________ Phone ___________________________ Address ________________________________________________________________________ ______________________________________________ Email ___________________________ Name _________________________________________ Phone ___________________________ Address ________________________________________________________________________ ______________________________________________ Email ___________________________ __ Enclosed is my tax-deductible contribution of: __ $1800 __ $1000 __ $500 __ $360 __ $180 __ $36 _______ Other Please make checks payable to The Shefa Fund. NOTE: Contributions from straight family and friends are encouraged. We may be able to match your contribution through a challenge grant from a gay, lesbian or bisexual contributor. Please check here if you want to be eligible for these matching funds: __.