Yavneh Healing List

Use this form to add individuals to Yavneh's healing list.

Names will be kept on the list until the end of the current month. Please re-submit names at the beginning of the following month if you would like them to remain on the list.

Individual you would like to add to healing list

Name

Hebrew name

Relation to you (e.g., self, mother, friend)

Please read silently

Your Contact Information

Submitter name

Submitter email

This address will receive a confirmation email

Phone

[OPTIONAL] If you would like to make a tzedakah offering, you can do so here

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Yavneh Healing List

Description

Please Fix the Following