Online Membership

All are welcome to join, regardless of background or affiliation!

Security Notice: Reservations are required to attend services.
No one will be turned away due to lack of funds.
If you or someone you know needs assistance with membership, please email [email protected]

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 The Family Shul?

Did you belong to any Shul before this?

Are you affiliated with any other Jewish organization?

Notes:

Community Member

$1212$101 Per Month

Community Friend If you're not yet ready to become a member

$648$54 Per Month

I'm going through a financial struggle. I'll pay: I'll try to support the community in other ways.

OnceMonthly

Specify Amount One Time Payment

Specify Amount Monthly Payment

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

The Family Shul 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 VIII: MEMBERSHIP PLAN

Section IX: Optional Partnership

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

Section X: Payment Information