HCS Chabad Membership

We welcome you to join our membership family and enjoy being part of our wonderful community!

Membership Rates:

$770 Family Membership
$385 Single Membership
$100 Junior Membership (does not include High Holiday Seats)

Membership Benefits:

• 2 Complimentary seats for High Holiday services / 1 Complimentary seat for single memberhip
• 50% discount on rental of the synagogue hall for simchas
• Belonging to an amazing Jewish community & building lifelong friendships

We’d love for YOUR FAMILY to become a part of OUR FAMILY! 

 I would like to renew my membership. All my information remains the same. 
      (Fill in the RED text fields on the form below and go to section 6 for payment)
I would like to renew my membership. Please note the changes to my information below.
     (Fill in the RED text fields and other updated fields on the form below and go to section 6 for payment)
 I would like to become a member (Fill in all sections as applicable and go to section 6 for payment)
 

SECTION I: YOUR INFO

   SECTION II: YOUR SPOUSE'S  INFO

Title
First Name                    Last Name

 

Title

 First Name Last Name
Hebrew Name   Hebrew Name
Father's Hebrew Name   Father's Hebrew Name
Mother's Hebrew Name   Mother's Hebrew Name
Occupation   Occupation
Birth Date / /
MM / DD / YYYY format 		  Birth Date / /
MM / DD / YYYY format
Jewish by: Birth Converted   Jewish by: Birth Converted
Check One: Cohen Levi Israel   Check One: Cohen Levi Israel



 

 

SECTION III: PERSONAL INFORMATION
Address   Email 1
City/State/Zip
City               State     Zip 		  Email 2
Home Phone   Marital Status  
Work Phone   Anniversary Date / /
MM / DD / YYYY format
Work Fax   If Divorced: If divorced, do you have a
Jewish "Get" ? Yes No



 

SECTION IV: CHILDREN

Name

 

Birth Date

 / /
MM / DD / YYYY format

Name

 

Birth Date

 / /
MM / DD / YYYY format

Name

 

Birth Date

 / /
MM / DD / YYYY format

Name

 

Birth Date

 / /
MM / DD / YYYY format

Name

 

Birth Date

 / /
MM / DD / YYYY format

Name

 

Birth Date

 / /
MM / DD / YYYY format
Are any children adopted? Yes No   If yes, give details, including any coversion info:

SECTION V: YAHRZEIT INFORMATION

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

Name
English / Hebrew / Father's Hebrew / Last

 

 / /
Date of Passing: MM / DD / YYYY		 Relationship

SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS
Family: $500 ~ Single: $250 ~ Associate $100
Payment Method:   Card Details:

Please bill me

 

Card Type:

  
Credit Card | full payment   Total Amount being charged today:
Credit card | 2 equal payments
(one now, one in 6 months)		   Card #:
      Exp. Date  
      Cvv Code

Optional Comments:



 

 

  **All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds. If you cannot afford the full amount requested, contact Rabbi Korf at [email protected]   for a confidential arrangement.