Membership 2024-2025

Address*

E-mail*
I would like to receive news and updates by email
Phone Number
Birth Date

Month Day Year
Hebrew Name
Parents' Hebrew Names
Spouse's Full Name

First Name Last Name
Spouse's Phone Number
Spouse's E-mail
Spouse's Birth Date

Month Day Year
Spouse's Hebrew Name
Spouse's Parents' Hebrew Names
Children's Names and Dates of Birth
Members receive free reserved seats for the High Holidays, discounts on the mikvah, preschool and space rental fees, as well as other perks throughout the year.
Membership Category* Your card will be billed monthly

Chabad Family Membership $1800 Annually • $150 MonthlyBronze Family Membership $2400 Annually • $200 MonthlySilver Family Membership $3600 Annually • $300 MonthlyGold Family Membership $5400 Annually • $450 MonthlyPlatinum Family Membership $9000 Annually • $750 Monthly
Monthly Chai Club : In addition to Membership, please charge my card a monthly donation of:

$18$36$54$100

Payment

Credit Card Check, Zelle, CashApp

Postal / Zip Code

Country

Total

$0.00
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).
E-Signature*
Date

Month Day Year
at Hour Minutes
Should you require assistance completing this form, please call us at 954-252-1770
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