Thank you for choosing to become a partner in the work Chabad does to help people.Below is the form to join the Chabad Club Membership. Please fill it out as best as you can. At the end of the form you can choose which level of commitment you'd like to make. You can also choose to pay your pledge as a one-time donation, or split it monthly over the course of the year. SECTION 1: YOUR INFOFull Name*First NameLast NameHebrew NameIf knownFirst NameLast NameMother's Hebrew NameIf knownFather's Hebrew NameIf knownBirth DateMonthDayYear E-mail*Jewishness*From BirthConvertNot JewishFamilyIf knownKohenLeviYisroelOccupationCell Number*Area CodePhone NumberWork NumberArea CodePhone NumberHome NumberArea CodePhone NumberSECTION 2: SPOUSE INFOIf applicableFull NameFirst NameLast NameHebrew NameIf knownFirst NameLast NameMother's Hebrew NameIf knownFather's Hebrew NameIf knownBirth DateMonthDayYear E-mailJewishnessFrom BirthConvertNot JewishFamilyKohenLeviYisroelOccupationCell NumberArea CodePhone NumberWork NumberArea CodePhone NumberHome NumberArea CodePhone NumberSECTION 3: PERSONAL INFORMATIONAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryMarital StatusSingleMarriedDivorcedWidowedIt's complicatedAnniversary DateMonthDayYear SECTION 4: CHILDRENIf applicableChild 1First NameLast NameBirth Date 1MonthDayYear Child 2First NameLast NameBirth Date 2MonthDayYear Child 3First NameLast NameBirth Date 3MonthDayYear Child 4First NameLast NameBirth Date 4MonthDayYear Are any of the children adopted?YesNoIf yes, please provide (confidential) informationHave they converted? When? With whom? etc.SECTION 5: YAHRTZEIT INFORMATIONIf applicablePlease click here to list all the dates of your family member's Yahrtzeits (dates of passing) As a Chabad Club member, these names will be added to the Yizkor book each year, free of charge.SECTION 6: MEMBERSHIP LEVELAny annual "no strings" donation of $1560 or more enters you into the Chabad Club.Membership OptionsOne share in Chabad's annual budget is $1560. Please choose an amount that is financially comfortable for you.Founder: $24,000 Annual - $2,000 MonthlyPlatinum: $18,720 Annual - $1,560 MonthlyGold: $12,000 Annual - $1,000 MonthlySilver: $9,240 Annual - $770 MonthlyBronze: $6,480 Annual - $540 MonthlyDouble Chai: $4,320 Annual - $360 MonthlyChai: $2,160 Annual - $180 MonthlyNest: $1,800 Annual - $150 MonthlyPartner: $1,560 Annual - $130 MonthlyAssociate: $770 Annual - $65 MonthlyI'd like toPay this donation all at once.Pay this donation monthly over the course of one year.Paying by check or credit card?Please write how much you will be paying or mailing today$0Total$0.00Yes, I'd like to donate the cost of processing this transaction by adding 3%PaymentCredit Card Check Credit CardVisaMasterCardAmerican ExpressCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearPlease bring or mail check to Chabad, 34 Cedar Street, Milford, MA 01757Billing AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryComments, Questions or SuggestionsI would like to receive news and updates by emailSubmitShould be Empty: This page uses TLS encryption to keep your data secure.