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Online Membership Form

Online Membership Form

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August 2016 - August 2017 
We invite you to join our growing family and become part of this wonderful community.

**High Holiday seats included with membership.

We are a diverse group of people from various levels of observance who come together for learning, spiritual growth, social interaction and friendship.

As we head into the 2016-2017 membership year, we reflect on the Chai Centers accomplishments of the past year and look forward to the future with excitement as it is filled with new opportunities for our continued growth. The success we have achieved since the opening of our building is a reflection of the dedication and support of our members. The Chai Center is truly dependent upon the financial resources provided through the support of a committed membership base.

With the High Holidays approaching, please take a moment to submit the below form. Upon receipt, we will email you a confirmation letter for your High Holiday seats. We look forward to your support as a member of Chai Center

If you would like more information, please do not hesitate to call the ChaI Center at (954) 341-9511.

RETURNING MEMBERS ABRIDGED UPDATE- PLEASE SKIP SECTION 5

SECTION I: ADULT MALE

SECTION II: ADULT FEMALE

Name

 

Name

Hebrew Name   Hebrew Name
Father's Hebrew
Name
  Father's Hebrew
Name
Mother's Hebrew
Name
  Mother's Hebrew
Name
Occupation   Occupation
Birth Date / /
MM / DD / YYYY format
  Birth Date / /
MM / DD / YYYY format
Business Phone   Business Phone
Cell Phone   Cell Phone
Email   Email
Jewish by: Birth Converted   Jewish by: Birth Converted
Check One: Cohen Levi Israel   Check One: Cohen Levi Israel

SECTION III: PERSONAL INFORMATION

Address   Marital Status
City/State/Zip   Anniversary Date / /
MM / DD / YYYY format
Home Phone   If Divorced: If divorced, do you have a
Jewish "Get" ? Yes No

SECTION IV: CHILDREN

Name

 

Birth Date

/ /
MM / DD / YYYY format

School Grade     Time of Day: (approx)

Name

 

Birth Date

/ /
MM / DD / YYYY format
School Grade     Time of Day: (approx)

Name

 

Birth Date

/ /
MM / DD / YYYY format
School Grade     Time of Day: (approx)
Are any children adopted? Yes No - If yes, give details, including any conversion info:

SECTION V: YAHRZEIT INFORMATION

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

High Holiday Attendance Form 5777-2015
All memberships include High Holiday seats. Family memberships include all minor children up to the age of 18, or children who have full-time student status.

ADULTS (enter names) CHILDREN (enter names & ages) GUESTS (enter names, list ages for kids)   Guest Rates
age age   Out of Town relatives of Members: $75 per person
age age   Local relatives of Members: $50/person
age age   Non-Members: $100/person
age age   Children: $15

Click here for a detailed schedule of all the holiday sevices.
Click here for a detailed schedule of children's programs.
Looking forward to seeing you on the High Holidays!

I am interested in participating in the following areas

Synagogue services Holiday Celebrations Leading the Service
Junior Congregation Youth Club Activities Reading from the Torah
Adult Education Teen Activities General Volunteering
Women's Circle Gan Shalom Preschool Cooking for Celebrations and Kiddushim
Sunday Hebrew School Early and after Care    

SECTION VI: MEMBERSHIP CONTRIBUTIONS

Membership

Annual  

Bi-Annual (9/1, 3/1)

Quarterly (9/1, 12/1, 3/ 1, 6/1) Monthly
Family $1,000   $500 $250 $85.00
Young/Senior Family (head of household under 30 or Hebrew school family and over 65) $650   $300 $165.00 $54
Single or Single Parent $500   $250 $125 $40.00
 
           
• Payment in full by cash, check or credit card
• Bi-Annual & Quarterly payments using a credit card on file only. Your credit card will be charged on the first business day of your selected payment schedule.
           
Please charge my: Visa M/C AMEX   Exp. Date
Card #:   CVV
           

SECTION VII: PARTNERSHIP OPPORTUNITIES

Although Chai Center does not have a mandatory building fund, Chabad needs your generous support above and beyond membership to maintain our facility, expand our programs and help those in need of scholarships. Please consider joining our select group.
$5,400 $3,600   $2,400 $1,800 $1,000
$500 $360   Other $  
I would like to designate my Partners of Chabad contribution to a specific fund:
General Fund Social Mitzvot Fund Children’s Scholarship Fund
Charity Fund Shabbos Kiddush Fund Education & Leadership Fund
Building Fund Rabbi’s Discretionary Fund Visiting the Sick Fund – Bikor Cholim
I would like to contribute the above total amount per the payment schedule below:
Full payment Bi-Annual   Quarterly Monthly  
Payment Method:
Use credit/debit card above   By Check  
     
SECTION VIII: REQUESTS FOR FINANCIAL ASSISTANCE
Chai Center Chabad wishes to accept all who want to be members and participate in its programs regardless of financial means. Our financial chair will contact you and a mutually agreed upon fee will be arranged. this will occur in a strictly confidential manner. No person or family will be turned away due to lack of financial means. Please use the following area to state reason for financial assistance request:

please contact me on my: home phone cell phone (as shown above)
     

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