Membership & Partnership 5786

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Monthly Membership Options*

Family Membership $125 monthly ($1,500 annually)Chai Membership $180 monthly ($2,160 annually)Gold $250 monthly ($3,000 annually)Diamond $360 monthly ($4,320 annually)Chabad Membership $1000 monthly ($12,000 annually)

For First-Time Members:
If this is your first time joining, please take a few moments to complete all the relevant information on the form. The more we know about you, the better we can include you in our services and community.

For Renewing Members:
If you’re renewing your membership, you can now skip directly to the payment section at the bottom of the form. However, if any of your information has changed, please update it on the form so we can keep our records accurate.

(1) Hebrew Name

(1H) First Name (1H) Last Name

(1) Father's Name

(1F) First Name (1F) Last Name

(1) Mother's Name

(1M) First Name (1M) Last Name

(1) Occupation

(1) Jewish By

BirthConverted

(1) Birth Date

Month Day Year

(1) I am a

CohenLeviIsrael

(1) Cell Phone

(1) Work Phone

(1) Home Phone

(1) E-mail

(1) Marital Status

Never been marriedMarriedWidowedDivorced

(1) Date Of Marriage

Month Day Year

(1) Date Widowed

Month Day Year

(1) Get Administred by:

Full Name

(S) First Name (S) Last Name

Hebrew Name

(SH) First Name (SH) Last Name

Father's Hebrew Name

(SF) First Name (SF) Last Name

Mother's Hebrew Name

(SM) First Name (SF) Last Name

(S) Occupation

(S) Birth Date

Month Day Year

(S) Jewish by

BirthConverted

(S) Spouse is a

CohenLeviIsrael

(S) Cell Phone

(S) Work Phone

(S) Home Phone

(S) E-mail

How many children do you have?

Child #1

Full Name

#1 First Name #1 Last Name

#1 Hebrew Name

#1 Gender

#1 School

#1 Birth Date

Month Day Year

#1 Birth time

MorningEvening

Child #2

Full Name

#2 First Name #2 Last Name

#2 Hebrew Name

#2 Gender

#2 School

#2 Birth Date

Month Day Year

#2 Birth Time

MorningEvening

Child #3

#3 Full Name

#3 First Name #3 Last Name

#3 Hebrew Name

#3 Gender

#3 School

#3 Birth Date

Month Day Year

#3 Birth Time

MorningEvening

Child #4

#4 Full Name

#4 First Name #4 Last Name

#4 Hebrew Name

#4 Gender

#4 School

#4 Birth Date

Month Day Year

#4 Birth Time

MorningEvening

Child #5

#5 Full Name

#5 First Name #5 Last Name

#5 Hebrew Name

#5 Gender

#5 School

#5 Birth Date

Month Day Year

#5 Birth Time

MorningEvening

How Many Yahrtzeit dates?

Name #1

[English / Hebrew / Father's Hebrew / Last]

YR1 Date and time of passing

Month Day Year

at Hour Minutes

YR1 Relationship

Name #2

[English / Hebrew / Father's Hebrew / Last]

YR2 Date and time of passing

Month Day Year

at Hour Minutes

YR2 Relationship

Name #3

[English / Hebrew / Father's Hebrew / Last]

YR3 Date and time of passing

Month Day Year

at Hour Minutes

YR3 Relationship

Name #4

YR4 Date and time of passing

Month Day Year

at Hour Minutes

YR4 Relationship

Total

$0.00

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The Shul