chabad logo.JPG

Chabad of Southwest Broward 5781 2020/2021

Personal Information

Family Name Home Phone

Address City, State, Zip

Your Details
Name Hebrew Name

Father's Hebrew Name Mother's Hebrew Name
Date of Birth
Hebrew Birthday
Work Phone Cell Email

Spouse Information
Name Hebrew Name
Date of Birth
Hebrew Birthday
Work Phone Cell Email

Marital Status

Married, Anniversary

Divorced, Date:

Child(ren) Information




Yahrtzeit (parents or children)

Name (English/Hebrew/Last) Father's Hebrew Name Relationship Date & Time of Death

Membership
 Chabad Family Membership $1200 Annually • $100 Monthly
Bronze Family Membership $1800 Annually • $150 Monthly
Silver Family Membership $3000 Annually • $250 Monthly
Gold Family Membership $3600 Annually • $300 Monthly 
Platinum Family Membership $5400 Annually • $450 Monthly 

*Monthly Chai Club : In addition to Membership, please charge my card a monthly donation of:

 



Location Update: We are working diligently to get our certificate of occupancy to hold High Holiday services at our new campus, but at the present time we have still not received approval, so services might have to be held at the old location on Stirling road.

High Holiday Seating: Due to the pandemic, social distancing and very limited seating, High Holiday seats will only be available for paid/paying Chabad members only.

Cooper City services will only be for adults and those over Bar/Bat Mitzvah. Reserve seating is a must. Walk-ins and non-reserved will not be allowed in. Masks must be worn and there will be no youth services.
 
All members paid in full can reserve 2 family seats included in your membership. Additional seats can be reserved for $50.
For those paying membership on the monthly plan, each High Holiday seat reserved will cost $50.
Again, because of very limited spacing, please reserve your seats immediately.

All men, women and children are invited Sunday, Rosh Hashana, September 20th at 1:30pm for a special outdoor family social distance “Shofar Blowing” and an abridged community High Holiday prayer, on the new property – 5960 SW 106Ave. 
This is open to all and is free of charge.
 

Yahrtzeit Plaque $540.00 memorial board.jpg

Yes, I would like to purchase a plaque in memory of a loved one.
Not at this time

Name

Hebrew Name

Father's Hebrew Name Date of Passing am pm

----------------------------------

Name Hebrew Name

Father's Hebrew Name Date of Passing am pm

Tree of Life Leaves $360.00

Yes I would like to purchase a leaf in honor of a family member or loved one.
Not at this time


In Honor Of:
In Honor Of:
In Honor Of:

Payment Options

Membership $ + Seats $ + Yahrtzeit Plaque $ + Tree of Life $ =

Total: $

I will send in a check made payable to Chabad of Southwest Broward.

Please charge my Credit Card in one payment.   Monthly over 12 payments
Card Number Exp. Date CCV
Billing Address (if Different)

I hereby certify that all information given above is true and correct and that I, and all members of my immediate family named herein, are Jewish by birth, or by conversion in accordance with Orthodox Jewish Law (Halacha).

Electronic Signature: Date:

Should you require assistance completing this form, please call us at 954-252-1770