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As we head into the 2024-2025 membership year, we reflect on the Shul’s accomplishments of the past year and look forward to the future with excitement as it is filled with new opportunities for our continued growth. The success we have achieved since the opening of our building is a reflection of the dedication and support of our members. The Chabad Center is truly dependent upon the financial resources provided through the support of a committed membership base.

Please note: Two Adult High Holiday seats are included with membership.  Upon completion of this form, we will email a form to confirm your seat selection. We look forward to your support as a member of Chabad.

SECTION I:  ADULT MALE

SECTION II:  ADULT FEMALE

 Name

 

 Name
 Hebrew Name    Hebrew Name
 Father's Hebrew 
 Name 		   Father's Hebrew 
 Name
 Mother's Hebrew
 Name		    Mother's Hebrew
 Name
 Occupation    Occupation
 Birth Date /  /
MM / DD / YYYY format 		   Birth Date /  /
MM / DD / YYYY format
 Business Phone    Business Phone
Cell Phone    Cell Phone
Email    Email
 Jewish by:   Birth    Converted    Jewish by:   Birth     Converted
 Check One:   Cohen   Levi   Israel    Check One:   Cohen   Levi   Israel

SECTION III:  PERSONAL INFORMATION
Address   Marital Status
 City/State/Zip   Anniversary Date /  /
MM / DD / YYYY format
 Home Phone   If Divorced: If divorced, do you have a
Jewish "Get" ?  Yes  No

SECTION IV: CHILDREN

 Name

 

 Birth Date

/  /
MM / DD / YYYY format

      School  Grade     Time of Day:  (approx)

 Name

 

 Birth Date

 /  /
MM / DD / YYYY format
      School  Grade     Time of Day:  (approx)

 Name

 

 Birth Date

 /  /
MM / DD / YYYY format
      School  Grade     Time of Day:  (approx)
 Are any children adopted?  Yes   No    If yes, give details, including any conversion info:
 

SECTION V: YAHRZEIT INFORMATION

 Name
English / Hebrew / Father's Hebrew / Last

 

 /  /
Date of Passing: MM / DD / YYYY 		Relationship

 Name
English / Hebrew / Father's Hebrew / Last

 

 /  /
Date of Passing: MM / DD / YYYY 		Relationship

 Name
English / Hebrew / Father's Hebrew / Last

 

 /  /
Date of Passing: MM / DD / YYYY 		Relationship

 Name
English / Hebrew / Father's Hebrew / Last

 

 /  /
Date of Passing: MM / DD / YYYY 		Relationship


SECTION VI: MEMBERSHIP CONTRIBUTIONS

Membership

Annual      
   Partner:   $10,000      
   Patron:  $5,000      
   Pillar:  $3,600      
   Benefactor :  $1,800      
   Family:

 $999

     
  Single Membership:                   $595      
  Associate Membership:                   $500      
         
Please charge my: Visa M/C  AMEX   Exp. Date

Card #:      CVV
         
 
 Additional comments

please contact me on my: home phone  cell phone      (as shown above)
         

Partners of Chabad 

The Chabad Center needs your generous support for our facility, programs and activities. In addition to membership, please consider joining our group called Partners of Chabad.  Thank you for your support. It is much needed and appreciated.

 


Total  Amount $ : 

To be contributed:  annually 
bi-annually quarterly