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Mikvah Listings Add

Do you have a new mikvah! Do you know of one we may have missed? Please take a few moments to help us out! Complete the following questionnaire and send it to us so we can add it to our directory! Take part in the mitzvah, we do thank you!
Date: 3/13/2010 12:57:41 AM Rep: 
Mikvah Name: 
Mailing Address: 
Mikvah Address: 
City: 
State: 
Zip: 
Proximity to nearest well-known city 
Cross streets:  between  & 
Mikvah Phone:  () Name: 
Mikvah Fax:  () Name: 
Home Phone:  () Name: 
Home Fax:  () Name: 
E-Mail Address: Mikvah:  Home: 
Is this an additional Mikvah in your city?  Yes
Is tdis a new Mikvah?  Yes
Does it replace an existing one?  Yes
that will no longer be operational?  Yes
If yes, list the Mikvah that should be removed from our database: 
Mikvah Attendant:  Tel: 
Person responsible for ordering supplies:  Tel: 
Supervising Rabbi(s): 
Shul / Org affiliation: 
Built By Rabbi: 
Number of: 
Mikvah pools:
Preparation rooms:
Bath:
shower:
Supplies provided? 
Date Mikvah was built: 
Date Mikvah was renovated (if applicable): 
Is your mikvah built (please check all that apply):  Bor al gabai bor (bor geshomim under immersion pool)
Side by side (bor geshomim on side of immersion pool)
   Side bor hashaka
      Side bor hashaka is bor al gabai bor
   Side bor zeriah
      Side bor zeriah is bor al gabai bor
Uncertain (please provide contact who could answer this question):
Name:
Phone:
Separate men's mikvah: 
Separate Keilim mikvah: 
Fee for use of Mikvah:     
Fee for a Kallah: 
Special treatment for a Kallah: 
Handicapped Accessible? 
By Appt. only? 
Shabbos and Yomtov only 
Summer Only 
By Appt. only? 
Advance Notice of: 
Comments: 
Image: 

   

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