Membership - Chabad of West Boca Raton

Membership 2026/2027

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*

$18,000 Founder of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and a private trip with Rabbi Bukiet to the Rebbe's Ohel))$10,000 Pillar of the Community (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and JLI course for a couple)$5,000 Gold Membership (Includes plaque in our lobby with your name, 4 High Holiday seats for adults and 2 VIP seats at lectures)$3,600 Honorary Membership (Includes plaque in our lobby with your name, 4 High Holiday seats for adults)$2000 Family Membership (Includes 2 High Holiday seats for adults)$1000 Single Membership (Includes 1 High Holiday seat for adult)$1000 Seasonal Associate Friend of Chabad
Membership to be paid:*

In Full12 monthly payments
Membership auto renewal*

YesNo
Comments
Eruv
Eruv Membership will run from Sept 1st 2026 - Aug 31st 2027
If you will be using the Eruv in West Boca, please consider helping cover the ongoing costs of its maintenance and inspection. The Eruv is a community service, and its continued upkeep depends on the support of those who rely on it.
Yearly Membership

$180
CHAI CLUB
To help support the activities of Chabad, we have created the Chai Club and are inviting you to become our partner. By becoming our partner through the Chai Club, you are committing to a monthly donation in a multiple of 18, or "Chai", which means life in Hebrew. 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$36$5490108144180360
MIKVAH MEI CHAYA MUSHKA & MIRIAM
Membership will run from Sept 1st 2026 - Aug 31st 2027
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 2026 - Aug 31st 2027
Yearly Rental

$180 Yearly rental of a locker which is located in the daily shul
Rental auto renewal

YesNo
PAYMENT
Membership can be paid in full or 12 monthly payments.

IMPORTANT: to select 12 monthly payments., choose the 8.3% option.
Total Membership

$0.00

I would like to pay today:Full amount8.3% minimum: $0.00 $

Payment*

Credit Card Check

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

PERSONAL INFORMATION

FAMILY SECTION

MEMBERSHIP PLAN

Eruv

CHAI CLUB

MIKVAH MEI CHAYA MUSHKA & MIRIAM

LOCKER RENTAL

PAYMENT