Please choose which action you need:

Add a Name to the List
Remove a Name from the List

Your Name *

First

Last

Email *

Email

Confirm Email

Please provide the best email address to use to contact with questions about submission.

Name to be added to Mi Shebeirach List *

First

Middle

Last

Middle Name is Optional.

Name to be removed from the Mi Shebeirach List *

First

Middle

Last

Middle Name is Optional.

Length on List *

2 Weeks
1 Month
Indefinitely

Please select how long you would like the name to remain on the list. Please use the "Indefinitely" option when required for an extended illness. In that case, please notify submissions@kolami-tx.org to have the name removed when appropriate.

Additional Comments

Mi Shebeirach List

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