Online Membership

Welcome to the Chabad Chayil family!

We're so happy you are joining our email list. You'll receive updates about upcoming events, holiday programs, classes, community news, and ways to get involved.

We'd love to get to know you a little better so we can send you information that's most relevant to you.

Please take a few minutes to introduce yourself to the best of your ability by filling out what you're comfortable sharing.

Full Name

Prefix First Name Last Name

Jewish Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date

Month Day Year

Jewish By:

BirthConvertedNot Jewish / Ben Noah (that should be by both spouses)

Check One:

CohenLeviIsrael

E-mail

Mobile Number

Area Code Phone Number

Full Name

Prefix First Name Last Name

Phone Number

E-mail

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date

Month Day Year

Jewish By:

BirthConverted

Check One

CohenLeviIsrael

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Number

Area Code Phone Number

Marital Status

Anniversary Date

Month Day Year

Previous Synagogue & Rabbi

City Married and Officiating Rabbi

If Divorced: Do you have a Jewish "Get"?

YesNo

Add Children

YesNo

Name Child 1

Birth Date Child 1

Month Day Year

Name Child 2

Birth Date Child 2

Month Day Year

Name Child 3

Birth Date Child 3

Month Day Year

Name Child 4

Birth Date Child 4

Month Day Year

Name Child 5

Birth Date Child 5

Month Day Year

Name Child 6

Birth Date Child 6

Month Day Year

Are any children adopted?

YesNo

Please give details, including conversion info:

1

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

2

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

3

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

4

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

5

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

6

English Name

First Name Last Name

Jewish Name

Relation

BenBas

Parent's Hebrew Name

Date of Passing:

Month Day Year

Relationship

Choose all that apply:

How did you find out about us?

Did you belong to any Shul before this?

Are you affiliated with any other Jewish organization?

Notes:

Other ways I can help the community

Builder Partner Helps support Jewish programming throughout the year.

$180/month ($2,160 per year)

Community Partner Helps strengthen holiday programs and community events

$360/month ($4,320 per year)

Leadership Partner Helps expand educational and outreach initiatives.

$540/month ($6,480 per year)

Visionary Partner Helps sustain major community growth and impact.

$1,000/month ($12,000 per year)

Legacy Partner Provides transformational support for Chabad's mission.

$1,800/month ($21,600 per year)

Founder Partner Provides foundational support for the future of our community.

$4,500/month ($54,000 per year)

All partners receive recognition on the Chai Club Wall according to their partnership level.

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Membership Form

SECTION I: YOUR INFO

SECTION II: SPOUSE'S INFO

SECTION III: PERSONAL INFORMATION

SECTION IV: CHILDREN

SECTION V: YAHRZEIT INFORMATION

1

2

3

4

5

6

SECTION VI: Please tell us which programs most interest you.

SECTION VII: GENERAL QUESTIONS

Section IX: Optional Partnership

All partners receive recognition on the Chai Club Wall according to their partnership level.

Section X: Payment Information