Printed from JewishWayne.com

Membership

Membership


    

MEMBERSHIP2.jpg

As we head into the 2017-2018 membership year, we reflect on the Shul’s 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 Chabad Center is truly dependent upon the financial resources provided through the support of a committed membership base.

Please note: Two Adult High Holiday seats are included with membership.  Upon completion of this form, click here to fill out the seat selection form.  We look forward to your support as a member of Chabad.

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 coversion 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


SECTION VI: MEMBERSHIP CONTRIBUTIONS

Membership

Annual      
   Benefactor:  $5000      
   Patron:  $3,500      
   Piller :  $1,800      
   Family:

 $935

     
 
  Single Membership:                   $505      
Please charge my: Visa M/C  AMEX   Exp. Date

Card #:      CVV
         
 
 Additional comments

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

         

Partners of Chabad 

The Chabad Center needs your generous support for our facility, programs and activities. In addition to membership, please consider joining our group called Partners of Chabad.  Thank you for your support. It is much needed and appreciated.

 


Total  Amount $ : 

To be contributed: 
annually 
bi-annually quarterly

 

Secure This page uses 128 bit SSL encryption to keep your data secure.