Printed from ChabadWestBoca.com

Membership

Please complete our membership form. 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 other than your name.
Family Section
Member information
Full Name*
First NameLast Name
Cell Number*
Area CodePhone Number
E-mail*

Address*

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

Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Birth Date
MonthDayYear
Born
DayEvening
Family
CohenLeviYisroelConvert
Home Number
Area CodePhone Number
Spouse (If applicable)
Full Name
First NameLast Name
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Family
CohenLeviYisroelConvert
Cell Number
Area CodePhone Number
Home Number
Area CodePhone Number
Birth Date
MonthDayYear
Born
DayEvening
E-mail
Personal Information
Marital Status
Anniversary Date
MonthDayYear
Children (If applicable)
Full Name
First NameLast Name
Birth Date
MonthDayYear
Born
DayEvening
Please check
MaleFemale
Full Name
First NameLast Name
Birth Date
MonthDayYear
Born
DayEvening
Please check
MaleFemale
Full Name
First NameLast Name
Birth Date
MonthDayYear
Born
DayEvening
Please check
MaleFemale
Full Name
First NameLast Name
Birth Date
MonthDayYear
Born
DayEvening
Please check
MaleFemale
Yahrzeits (parents or children)
Full Name
First NameLast Name
Hebrew Name
Relationship
Date of passing
MonthDayYear
Time of Day
DayEvening
Full Name
First NameLast Name
Hebrew Name
Relationship
Date of passing
MonthDayYear
Time of Day
DayEvening
Full Name
First NameLast Name
Hebrew Name
Relationship
Date of passing
MonthDayYear
Time of Day
DayEvening
MEMBERSHIP PLAN
Please choose your membership option.
Membership Options*
$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
Comments
HIGH HOLIDAY SEAT RESERVATIONS
In accordance to the CDC guidelines, we will be implementing a 6-foot distance between yourself and others during the services. Due to this, we will need to limit the number of attendees at the services. We will be holding multiple services throughout the day. Members will get preference of which service they would like to attend.
Rosh Hashana
How many Men seats do you require?
How many Women seats do you require?
Rosh Hashanah Day 1 (Saturday September 19th)Choose your desired service
9:00am – 12:00pm (full service)1:00pm – 2:00pm(Short service)
Rosh Hashanah Day 2 (Sunday September 20th)Choose your desired service
9:00am – 12:00pm (full service)1:00pm – 2:00pm (Short service including Shofar Blowing)5:30pm Family Service followed by Tashlich
Yom Kippur
How many Men seats do you require?
How many Women seats do you require?
Yom Kippur Night (Sunday September 27th)Choose your desired service
6:55pm (Kol Nidrei)
Yom Kippur Day (Monday September 28h)Choose your desired service
9:00am – 2:00pm (full service)3:00pm – 4:00pm (Short service including Yizkor Prayer)6:40pm (Neila)
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
Yes, I would like to be a member
$280 Yearly Membership for the Mikvah
LOCKER RENTAL
Yearly Rental
$180 Yearly rental of a located in daily shul
Total
$180.00
PAYMENT
Your credit card will not be charged until the office has received and processed your membership form.

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

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.

Family Section

MEMBERSHIP PLAN

HIGH HOLIDAY SEAT RESERVATIONS

CHAI FOR LIFE

MIKVAH MEI CHAYA MUSHKA & MIRIAM

LOCKER RENTAL

PAYMENT