Please submit the following information to request an appointment at the Charlotte Goldberg Community Mikvah.

Name (required)

Email (required)

Address (required)

Phone Number (required)

Desired Date - please list 3 dates (required)

Desired Time (required)

Synagogue or Temple Affiliation

Hebrew Name

Reason for Visit

Gender
FemaleMale

Is there anything else you would like us to know to help you prepare for your visit?