To learn more about the partnership/Chabad Club membership program, click here.
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Partner.jpg

SECTION I: YOUR INFO   SECTION II: SPOUSE'S INFO
Name   Name

Hebrew Name
(if known)		   Hebrew Name
(if known)
Father's Hebrew Name
(if known. If not, English name)		   Father's Hebrew Name
(if known)
Mother's Hebrew Name
(if known. If not, English name)		   Mother's Hebrew Name
(if known)
Occupation   Occupation
Birth Date / /   Birth Date / /
Jewish by: Birth Converted   Jewish by: Birth Converted
Check One: Cohen Levi Israel   Check One: Cohen Levi Israel
SECTION III: PERSONAL INFORMATION
Address   Email (you)
City/State/Zip / /   Email (spouse)
Home Phone   Marital Status
Work Phone (you)   Anniversary Date / /
Work Phone (spouse)   If Divorced: Do you have a Jewish "Get"?
Yes No
Cell Phone (you)      
Cell Phone (spouse)      
SECTION IV: CHILDREN

Name

  

Birth Date

 / /

Name

  

Birth Date

 / /

Name

  

Birth Date

 / /

Name

  

Birth Date

 / /

Name

  

Birth Date

 / /

Name

  

Birth Date

 / /
Are any children adopted? Yes No   If yes, give details, including any conversion info:
SECTION V: YAHRZEIT INFORMATION, these names will be added to the Yizkor book each year, free of charge.

Name

   / /
Date of Passing 		Relationship

Name

   / /
Date of Passing 		Relationship

Name

   / /
Date of Passing 		Relationship

Name

   / /
Date of Passing 		Relationship

Name

   / /
Date of Passing 		Relationship

Name

   / /
Date of Passing 		Relationship
SECTION VI: PARTNERSHIP OPPORTUNITIES
In our effort to be inclusive for families of all income levels, Partnership Opportunities have been designed within a wide range. However, if you are capable, please consider participating at a higher level. This will allow us to cover our expenses and continue to offer and expand our fee-free programs, services and long term goals. All Partnership gifts can be made in one installment or in 12 monthly installments. Please check the option of your choice. Nobody will be turned away due to lack of funds.
Founder $2,000 Monthly - $24,000 Yearly
Platinum Partnership $1,000 Monthly - $12,000 Yearly
Gold Partnership $500 Monthly - $6,000 Yearly
 "Double Chai" Partnership $360 Monthly - $4,320 Yearly
Bronze Partnership $250 Monthly - $3,000 Yearly
Chai Partnership $150 Monthly - $1,800 Yearly
Chabad Club Partnership $130  Monthly - $1,560 Yearly
   
Associate CC Partnership $64 Monthly - $770 Yearly
Friendly Partnership $28 Monthly - $336 Yearly
   
Any partnership amount equal to, or above $1560 a year, automatically enters you into the "Chabad Club."
SECTION VII: PAYMENT INFORMATION
  Payment Method: Card Number:
  Exp. Date CVV Code:
  Billing Zip Code    
  Optional Comments: I wish to pay the full annual donation now
I wish to pay 12 Month Installments
You will be charged at the beginning of each month.
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Other payment option:
       
   

TOTALS:

 
    Partnership Total Amount:

    Total Amount to be charged today (or sent in the mail):

* All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds. If you cannot afford any of the above amounts, and want to participate, please contact the Rabbi for other ways you can help.