Membership Online Form

Membership 5785
For current members renewing membership click here

For High Holiday Seats only click here
Family Name

Address

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

Phone Number

Area Code Phone Number
E-mail*
Personal Informantion
Full Name
First Name Last Name
Hebrew Name
First Name Last Name
CohenLeviYisroelConvertAdopted
Birth Date

Month Day Year
E-mail
Phone Number

Area Code Phone Number
Spouse
First Name Last Name
CohenLeviYisroelConvertAdopted
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
E-mail
Phone Number

Area Code Phone Number
Child #1
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Child #2
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Child #3
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Child #4
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Child #5
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Name of School/s do your children attend
Are any of the above listed children adopted?
Anniversaries & Yahrzeits
Anniversary

Month Day Year
Yahrzeit

Month Day Year
Hebrew Name of deceased
Yahrzeit

Month Day Year
Hebrew Name of deceased
Yahrzeit

Month Day Year
Hebrew Name of deceased
Yahrzeit

Month Day Year
Hebrew Name of deceased
Payment Information
Annual Family Membership $1000

(includes children's groups & 2 seats for High Holidays )

additional seats for immediate family members $80

Individual Membership $770

(includes 1 seat for High Holidays)

Chai Club Partnership $1800

(includes children's groups & 4 seats for immediate family members)

Security Fund Contribution

suggested amount $400

We urge all families to include the security fee in your membership payments to help ensure a safe environment for all congregants.
Everyone is welcome to Chabad. Membership enables us to keep our doors open, and cover the basic epenses of the shul. If you can not afford membership, please reach out to Rabbi Barash.
Select a package*

$1000$770$1800
Security Contribution*

$400
Locker ($325 -$360 for new locker $150 for renewal)

$150$325$360
Additional Seats
Yizkor Book Dedication / Memorial Board Plaque
Quarter Page $36
Half Page $54
Full Page $90
Plaque $360
During the month of the Yahrzeit and for the holidays when Yizkor is said, the light next to your loved one's name is lit.
We will call you for the details of your dedication
Yizkor Book/Memorial Board

$36$54$90$360
List names of family members needing seats for RH (2 seats for regular members, 4 seats for Chai Members)
List names of family members needing seats for YK (2 seats for regular members, 4 seats for Chai Members)
List names and ages of children attending kids groups. (Parents must be at Shul, if dropping children off at groups)
Sponsorship & Volunteer Opportunities

I would like to sponsor a Hebrew/English Annotated Machzor for RH & YK at $45 per setI would like to sponsor a Hebrew/English Annotated Machzor for RH at $20 eachI would like to sponsor a Hebrew/English Annotated Machzor for YK at $25 eachI can help build the Shul's Community SukkahI can help take down the Shul's Community Sukkah

Payment*

Credit Card Other

Postal / Zip Code

Country

All Holiday purchases are due before the holidays. Please select below a payment plan for your membership. For financial aid please don't hesitate to call our office (954) 965 9933
Payment Options*

Please charge my card in 5 installmentsPlease charge my card in 10 installmentsPlease charge my card once for the full amountPlease contact me for other methods of payment
Total Charges

$400.00
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Programs

Membership Online Form

Membership 5785

Personal Informantion

Anniversaries & Yahrzeits

Payment Information

Babyccino

Adult Education

JIT Chabad Preschool

Holiday Celebrations

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