Membership - ChabadOceanDrive.com

Membership 2022-23/5783 Online Form

SECTION I: MEMBER NAME

Full Name*

First NameLast Name

All my information is the same as last year.

Hebrew Name*

Father's Hebrew Name*

Mother's Hebrew Name*

Occupation*

Birth Date*

MonthDayYear

Check One:*

CohenLeviIsrael

Check One:*

Jewish by birth.Converted.

Details:

Yes, I would like to add:

My SpouseChildrenYarzteits

SECTION II: SPOUSE'S INFO (Optional)

Full Name

First NameLast Name

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date

MonthDayYear

Check One:

CohenLeviIsrael

Check One:

Jewish by birth.Converted.

Details:

SECTION III: PERSONAL INFORMATION (Optional)

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Work Fax

Area CodePhone Number

E-mail 1

E-mail 2

Marital Status

Anniversary Date

MonthDayYear

SECTION IV: CHILDREN (Optional)

Names of Children and Birth DatesEx: Chana Dec. 4, 2001

Are any children adopted?

YesNo

If yes, give details, including any conversion info:

SECTION V: YAHRZEIT INFORMATION (Optional)

Yahrzeit 1

1. NameEnglish / Hebrew / Father's Hebrew / Last

1. Date of Passing

MonthDayYear

1. Relationship

Yahrzeit 2

2. NameEnglish / Hebrew / Father's Hebrew / Last

2. Date of Passing

MonthDayYear

2. Relationship

Yahrzeit 3

3. NameEnglish / Hebrew / Father's Hebrew / Last

3. Date of Passing

MonthDayYear

3. Relationship

Yahrzeit 4

4. NameEnglish / Hebrew / Father's Hebrew / Last

4. Date of Passing

MonthDayYear

4. Relationship

SECTION VI: MEMBERSHIP & PARTNERSHIP OPPORTUNITIES

You fuel Jewish Life in Hallandale/Hollywood Beach happens with your generous support. Membership plays an important role providing a warm and welcoming environment for services, community events, and adult education. Thank You for joining.

Members will receive discounts on various community classes and events throughout the year.

Please select*

Standard Membership: $1200 (includes 4 High Holidays Seats)Supporter Membership: $1800 (includes 4 High Holidays Seats)Executive Membership: $3600 (includes 4 High Holidays Seats + High Holiday Honor)Shareholder Membership: $5400 (includes 4 High Holidays Seats + High Holiday Aliya)Snowbird Membership: $720 (6 months minus 1 day)Snowflake Membership: $540 (Less than 3 months)Flexible ($1-$99 monthly) __ (includes 2 High Holiday Seats) - Specify $ below.

Please accept my monthly donation of:

$

Total

$0.00

Payment

Credit Card Check in the mail.

Postal / Zip Code

Country

Comments