Shining Stars 2024 - Menorah Park

Resident/Honoree Name:*

The Menorah Park Resident Lives at:*

Resident's Hometown:*

Resident's Educational Background:*

Resident's Employment Highlights:*

Resident's Military Service - Branch? When Served? (N/A if not pertinent)*

Resident's Hobbies:*

Name of Person Providing Information:*

First Last

Relationship to Resident:

Email Address*

Best Number to Reach Me Days:*

Upload Image of the Resident

Accepted file types: jpg, jpeg, png, gif.

Your Ad Text (n/a if not purchasing ad):*

Order:*

Total

$0.00

Please type in the following information and submit with this nomination as signature to the below: I (insert full name in space below)*

hereby declare that Menorah Park has my full permission to use my/the resident’s name, photographs, and likeness in their Shining Stars 2024 Event Documents. The Shining Stars 2024 Event Documents encompasses, but is not limited to social media posts, testimonials, case studies, brochures, videos and other Shining Stars 2024 Event Documents. I fully understand that the aforementioned information will be used by Menorah Park in the Shining Stars 2024 Event documents. I acknowledge that Menorah Park shall refrain from disclosing or selling my information to third-parties for personal gains. I certify that I am over 18 years of age, or have authority to execute this consent on behalf of the individual referenced above, and I fully understand and agree to the terms and conditions provided by Menorah Park in regard to using my personal information for Shining Stars 2024 Event Documents. Resident Name:*

Name of Person Submitting/Signing:*

Date of Submission:*

Authority to Sign on Behalf of Resident (Daughter, Son, Friend, etc.)*

Financial and other information about the purposes, programs and activities of the Foundation at Menorah Park can be obtained by contacting Michael Riley, CFO, at 4101 E Genesee St, Syracuse, NY 13214; (315) 446-9111; [email protected]. A recently filed financial report is available from the Charities Registry on the New York State Attorney General’s website at www.charitiesnys.com or, upon request, by contacting the New York State Attorney General, Charities Bureau, at 28 Liberty Street, New York, New York 10005 or by calling (212) 416-8401.

Name
This field is for validation purposes and should be left unchanged.