2016-2017 Membership Registration


Download a .pdf of the Membership Form 5777 that you can print out and mail in with a check.





Membership Information

Single & Family Membership Includes:

• Services of the Rabbis at all lifecycle events

• Bar/Bat Mitzvah facilitation

• Discounted Chabad Hebrew School tuition

• 30% discount on facility rental fees

• Weekly e-newsletter and other communications

• First opportunity/advanced notice for reserved High Holiday seating

• Discounts on JLI classes

• High Holiday reserved seating for couple and children under 25


Enhanced Membership Includes:

• All the features of Membership

• Kiddush for one occasion of your choice (Please call the office to reserve your special date) 


Associate Membership Includes:

• Weekly e-newsletter and other communications

• First opportunity/advanced notice for reserved High Holiday seating

• Discounts on JLI classes

• 2 reserved seats at High Holiday events


Hebrew School Tuition

• Members: $650

• Non-members: $950


Kiddush Sponsorship: $400

Member Information

Hebrew Name
Hebrew Father
Hebrew Mother
Date of Birth

Spouse's Information

Spouse's name
Spouse's Jewish name
Spouse's date of birth
Spouse's father's Jewish name
Spouse's mother's Jewish name


Child 1 name
Child 1 Jewish Name
Child 1-birthdate
Child 2 name
Child 2 Jewish name
Child 2-birthdate
Child 3 name
Child 3 Jewish name
Child 3-birthdate
Child 4 name
Child 4 Jewish name
Child 4-birthdate
Child 5 name
Child 5 Jewish name
Child 5-birthdate
Child 6 name
Child 6 Jewish name
Child 6-birthdate
Do you have college age children? What are their names and e-mail address(es)?


Yahrzeits (please provide name and date)
State / Province*
Confirm Email*
Cell Phone
Primary Program Interests
  • Camp Gan Israel
  • CTeen
  • Downtown Chabad
  • Friendship Circle
  • Hebrew School
  • JLI
  • LifeTown
  • Preschool Programming
  • Shule
  • Women
Other Interests
  • Attending weekly classes
  • Hebrew School
  • Chevra Kadisha
  • Shabbat Morning Minyan
  • Women Chessed Group
  • Men's Club
  • Shabbas Club
  • Youth Group

Payment Information

Name on Card*
Card Number*
Additional Comments

Security Code

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