Become a MEMBER and enjoy special valuable benefits & exciting new perks!

Chabad of the Five Towns | Membership - Join our Family today!


Returning members, click here

SECTION I | Your Information
Last Name
First Name
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Occupation
Birth Date [DD / MM / YYYY]
Day
Night		 Jewish by
Birth Conversion		 I am a
Cohen Levi Israel
Cell Phone
Work Phone
Email
SECTION II | Spouse's Information
Last Name
First Name
Hebrew Name
Father's Hebrew Name Mother's Hebrew Name Occupation
Birth Date [DD / MM / YYYY]
Day
Night		 Jewish by
Birth  Conversion  Not Jewish		 I am a
Cohen Levi Israel
Cell Phone
Work Phone
Email
SECTION III | Personal Information
Address
City/State/Zip
Home Phone
Marital Status: Single Never been Married Married Divorced Widowed
Anniversary Date [DD / MM / YYYY]
Divorce Date
(if applicable) [DD / MM / YYYY]
If divorced, do you have a Jewish Get?
Yes No		 Who was Get administered by?
Widowed Date (if applicable) [DD / MM / YYYY]
SECTION IV | Children
Child 1 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 2 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 3 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 4 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 5 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 6 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 7 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
Child 8 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ / 		Day Night School
  Are any children adopted?
Yes No		 If yes, give details, including any conversion info:
SECTION V | Yahrtzeits
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]

Day
Night		 Relationship
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]
Day
Night		 Relationship
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]
Day
Night		 Relationship
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]
Day
Night		 Relationship
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]
Day
Night		 Relationship
Name

[English / Hebrew / Father's Hebrew / Last]		 Date of Passing [DD / MM / YYYY]
Day
Night		 Relationship
Section VI | Membership Opportunities

Basic Membership

• Complimentary tickets to Annual Membership Melava Malka Gala
• Two High Holiday seats
• Listing of departed loved ones in Yizkor Booklet
• 25% discount on Hebrew School
• 20% discount on Bar/Bat Mitzvah fees (after 1st year of membership – must be enrolled in our Hebrew School)
• 5% discount on Gan Chamesh Preschool 2019 - 2020 
• 10% discount on most events and programs
• Menorah & Candles for Chanukah mailed to college age children at school
• Life Cycle event services
• Meals delivered for new babies and shiva
• Belonging to an amazing Jewish community & building lifelong friendships

The Annual Dues Scheule:
$1,440 Family Membership $120 Monthly Payment $770 Single Membership
TREE OF LIFE PARTNERSHIP CLUB – A MONTHLY DEDICATION OPPORTUNITY
Tree of Life partnership Club includes Membership Benefits and a leaf dedication plaque on the beautiful Tree of Life Wall
Chai - $180 Double Chai - $360 Triple Chai - $540
Chabad Connection - $770
Includes all of the above and 2 seats to Chabad’s Annual Dinner		    
Includes all of the above benefits plus a prominent Aliyah at High Holiday Services, admission with RSVP to any Chabad event gratis:
Builder - $1,300 Chai Minyan - $1,800 Hashem's Partner - $2,600
Silver Partner - $3,600 Gold Partner - $5,400 Diamond Partner - $7,200
Jubilee Chai Partner - $9,000    
Includes all of the above benefits and a complimentary table at Chabad’s Annual Dinner:
Visionary - $10,000 Community Pillar - $13,000 Chai Chazak- $18,000
Section VII | High Holiday Seat Reservations Click Here to reserve your High Holiday Seats - Use Discount Code: MEM for 2 free seats
Section VIII | Payment Authorization

I would like to make a one time payment for everything pledged above. Please charge my card below.
I would like to make recurring monthly payments for membership (not including today's payment). Please charge my card below on the first of every month.
I would like to make recurring monthly payments for building fund (not including today’s payment). Please charge my card below on the first day of every month.
I would like to make recurring monthly payments for High Holiday Seats (not including today’s payment). Please charge my card below on the first day of every month.
Total Amount Pledged - Membership
$ 		Total Amount Pledged - High Holiday Seats
$ 		Total Amount Pledged - Tree of Life
$
Comments/Special Requests
Amount to be charged TODAY
[First recurring payment or one time amount]
$ 		Card Type
Card Number
Expiration Date
Card Security Code
I hereby certify that all information given above is true and correct.