Printed from ChabadRT.org

Chai Club Form

Chai Club Form

Chai Club Membership is not compulsory. All are welcome to attend any of Chabad's programs.

Please use my information from last year (All you need to fill out below is your name and payment information)

YOUR INFORMATION SPOUSE INFORMATION
Name

Hebrew Name

Occupation

Company's Name

Work Phone

Birth Date

Email

Is biological father Jewish? Yes No
Is biological mother Jewish? Yes No
Any Conversions in family? Yes No
If yes provide details
       
Name

Hebrew Name

Occupation

Company's Name

Work Phone

Birth Date

Email

Is biological father Jewish? Yes No
Is biological mother Jewish? Yes No
Any Conversions in family? Yes No
If yes provide details

 

PERSONAL INFORMATION
Address

City/State/ Zip

Home Phone

Marital Status

Anniversary Date

 
CHILDREN
Name

Name

Name

Name

Name

Name

  * Please include Hebrew Name in parentheses
   
Birth Date

Birth Date

Birth Date

Birth Date

Birth Date

Birth Date

 
YARTZEITS
NAME(English) HEBREW NAME RELATIONSHIP DATE OF DEATH
MEMBERSHIP CONTRIBUTIONS

Chai Club Founder's Club - $5,000
[or $416 per month]

 

Chai Club Partner - $3,600
[or $300 per month]

 
FAMILY CHAI CLUB - $1,800
[or $150 per month]
 
Hebrew School Family - $1000
[or $84 per month]
 
Chai Club (seasonal, single etc) - $700
[or $58 per month]
 

 

METHOD OF PAYMENT

One Full Payment of $
Monthly Payments $

Please bill me
Please charge my card
Card Number:
Expiration Date:
CAPITAL CAMPAIGN
I'd like to make an additional donation to help pay down the mortgage.
$54 $72 $180 $360 Other

Membership is renewed each year unless otherwise stated.

 

All contributions are tax deductible to the fullest extent allowed by law.

Comments:

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