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, 2017 – August 31, 2018.
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