Membership

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
Should be Empty:

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Holiday Date