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

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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
• Two High Holiday seats & priority seat reservation based on CDC guidelines 
Listing in the new membership directory
Family birthdays listed in the annual Chabad calendar
• Listing of departed loved ones in Yizkor Booklet
• 25% discount on Hebrew School
• Discounted Bar/Bat Mitzvah fees (after 1st year of membership – must be enrolled in our Hebrew School)
• 5% discount on Gan Chamesh Preschool 2020 - 2021
• 10% discount on most events and programs
• Mezuzah gift for college age children

• Life Cycle event services
• Meals delivered for new babies and shiva
• Belonging to an amazing Jewish community & building lifelong friendships


The Annual Dues Scheule:
$1,200 Family Membership $100 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
High Holiday seat reservations will open in mid August - members will receive 2 seats complimentary
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.

As always Chabad has an Open Door Policy. No one will be turned away from membership for financial reasons.  If you cannot pay full membership please contact please contact Rabbi Wolowik once completing this form. 
Total Amount Pledged - Membership
$ 		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.