Membership

Membership 2023/2024

Please complete our membership form.
PERSONAL INFORMATION
Full Name*

First Name Last Name
Cell Number*

Area Code Phone Number
Home Number

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

FAMILY SECTION

If you are a current member and there are no changes from last year, there is no need to fill out the family information section
Family Section*

I am a current member with no changes from last yearI am current member and would like to update my informationI am a new member
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Birth Date

Month Day Year
Born

DayEvening
Family

CohenLeviYisroelConvert
Spouse (If applicable)
Full Name

First Name Last Name
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Family

CohenLeviYisroelConvert
Cell Number

Area Code Phone Number
Home Number

Area Code Phone Number
Birth Date

Month Day Year
Born

DayEvening
E-mail
Marital Status
Anniversary Date

Month Day Year
Children (If applicable)
1.Full Name

First Name Last Name
Birth Date

Month Day Year
Born

DayEvening
Please check

MaleFemale
2. Full Name

First Name Last Name
Birth Date

Month Day Year
Born

DayEvening
Please check

MaleFemale
3. Full Name

First Name Last Name
Birth Date

Month Day Year
Born

DayEvening
Please check

MaleFemale
4. Full Name

First Name Last Name
Birth Date

Month Day Year
Born

DayEvening
Please check

MaleFemale
Yahrzeits (parents or children)
1. Full Name

First Name Last Name
Hebrew Name
Relationship
Date of passing

Month Day Year
Time of Day

DayEvening
2. Full Name

First Name Last Name
Hebrew Name
Relationship
Date of passing

Month Day Year
Time of Day

DayEvening
3. Full Name

First Name Last Name
Hebrew Name
Relationship
Date of passing

Month Day Year
Time of Day

DayEvening
MEMBERSHIP PLAN

Please choose your membership option.
Membership Options*

$26,000 Builders of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$18,000 Founder of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$10,000 Pillar of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$5,000 Gold Membership (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$3,600 Honorary Membership (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$1,800 Family Membership (2 High Holiday seats for adults)$900 Single Membership (Includes 1 High Holiday seat for adult)$720 Seasonal Associate Friend of Chabad
Membership to be paid:*

In Full12 monthly payments
Membership auto renewal*

YesNo
Comments
Annual Fees
Annual Fees

$1000 Building Fund (Maintenance & Mortgage Debt$250 Security fee ( Armed Security Personal On Campus)$180 City-Wide Eruv
CHAI FOR LIFE
A contribution of "chai" ($18 or multiples of "chai" per month is a great way to ensure continuous Tzedakah and help our fiscal responsibilities. The contribution you make will be charged to your card monthly.
Monthly contribution

$18 Chai for Life$36 Double Chai$54 Triple Chai
MIKVAH MEI CHAYA MUSHKA & MIRIAM

Membership will run from Sept 1st 2022 - Aug 31st 2023
I would like to be a member

$450 Yearly Men's Membership for the Mikvah
Membership auto renewal

YesNo
LOCKER RENTAL

Locker rentals will run from Sept 1st 2022 - Aug 31st 2023
Yearly Rental

$180 Yearly rental of a located in daily shul
Rental auto renewal

YesNo
PAYMENT
Your credit card will not be charged until the office has received and processed your membership form.
Total

$0.00

Payment*

Credit Card Check

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

PERSONAL INFORMATION

FAMILY SECTION

MEMBERSHIP PLAN

Annual Fees

CHAI FOR LIFE

MIKVAH MEI CHAYA MUSHKA & MIRIAM

LOCKER RENTAL

PAYMENT