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Membership

Membership

Creating a growing and dynamic community is a partnership and collective effort. Your membership and support over the past years is greatly valued and appreciated. Our partnership is even more critical as we move forward in these exciting times.

Please fill out this membership form and please consider an increase in your membership level for the coming year, as your circumstances allow.

High Holiday seats included with membership. Please reserve your seats -
click here for our seat reservation form.

YOUR INFORMATION
Gender Male Female Title
First Name Last Name
Hebrew Name Occupation
Mother's Hebrew Name Father's Hebrew Name
Birth Date Time of Birth (Approx.)
Cell Phone Work Phone
Email Home Phone
Address City, State, Zip
City State Zip
Birth Mother Jewish by Birth Converted
Did You Convert? No Yes
For Male Members Kohen iLevite Israelite
Marital Status Married Separated Divorced Widowed
If Married, Date of Marriage
YOUR SPOUSE'S INFORMATION
Gender Male Female Title
Name Hebrew Name
Mother's Hebrew Name Father's Hebrew Name
Birth Date Time of Birth (Approx.)
Occupation Email
Cell Phone Work Phone
Birth Mother Jewish by Birth Converted
Converted? No Yes
For Males Members KohenLevite Israelite
YOUR CHILD/CHILDREN'S INFORMATION
1. Child's Name School
Birth Date Time of Birth (Approx.)
2. Child's Name School
Birth Date Time of Birth (Approx.)
3. Child's name School
Birth Date Time of Birth (Approx.)
4. Child's Name School
Birth Date Time of Birth (Approx.)

YAHRTZET INFORMATION
1. Hebrew Name Father's Hebrew Name
English Name Relation
Date of Passing Time of Day (Approx.)
2. Hebrew Name Father's Hebrew Name
English Name Relation
Date of Passing Time of Day (Approx.)
3. Hebrew Name Father's Hebrew Name
English Name Relation
Date of Passing Time of Day (Approx.)
4. Hebrew Name Father's Hebrew Name
English Name Relation
Date of Passing Time of Day (Approx.)

I AM INTERESTED IN PARTICIPATING IN THE FOLLOWING AREAS:
Synagogue Services Holiday Celebrations Camp Gan Israel
Junior Congregation Youth Zone Seniors Sunshine Club
Adult Education Classes Torah Teens Young & Jewish S.A. (YJSA)
Women's League of Chabad Gan Gani Preschool Community Mikva
Sunday Hebrew School Jewish Learning Institute Volunteering

MEMBERSHIP OPTIONS
Membership is from September 1, 2016 – August 31, 2017.
High Holiday seats included with membership. Please reserve your seats - click here for seat reservation form.

New members: please call the office for our special reduced membership fee.
Chabad does not turn anyone away for lack of ability to pay. Please call the office to arrange for a confidential
visit to discuss special arrangements.
$1,200 Member $1,800 Sponsor $2,400 Patron
$3,000 Benefactor $4,200 Pillar $6,000 Angel
Other
I would like to pay the above membership amount per the payment schedule below:
Full Payment Now Bi-Annual (Sept.1, Mar 1)
Quarterly (Sept. 1, Dec. 1, March 1, June 1) Monthly (Sept. 1 - Aug. 1)

CHABAD CHAI CLUB
The Chabad Center for Jewish Life & Learning provides many diverse community services. Please consider an additional contribution to one of the funds listed below to enable us to continue these vital programs.
Suggested Annual Levels of Giving:
$5,400 $3,600 $2,400 $1,800 $1,000 $540 $360 Other
I would like to designate my Chabad Chai Club contribution to a specific fund:
General Fund Community Eruv Fund Seniors Sunshine Club
Adult Education Camp Gan Israel Scholarships Young & Jewish S.A. (YJSA)
Women's League of Chabad Gan Gani Preschool Scholarships Community Mikvah Fund
Building Fund Rabbi's Discretionary Fund Visiting The Sick/Bikur Cholim
I would like to contribute the above Chai Club amount per the payment schedule below:
Full Payment Now Bi-Annual (Sept.1, Mar 1)
Quarterly (Sept. 1, Dec. 1, March 1, June 1) Monthly (Sept. 1 - Aug. 1)

PAYMENT INFORMATION
Total amount to charge my card
TODAY:
Exp. Date
Card Type Card Code
Card Number Comments

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