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New Members

New Members

New for this year:
Become a MEMBER and enjoy special valuable benefits & exciting new perks!

Chabad of the Five Towns | Membership - Join our Family today!

Returning members, click here

SECTION I | Your Information
Last Name
First Name
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Occupation
Birth Date [DD / MM / YYYY]
Day
Night
Jewish by
Birth Mother Jewish at birth Maternal Grandmother Jewish at birth
I am a
Cohen Levi Israel
Cell Phone
Work Phone
Email
SECTION II | Spouse's Information
Last Name
First Name
Hebrew Name
Father's Hebrew Name Mother's Hebrew Name Occupation
Birth Date [DD / MM / YYYY]
Day
Night
Jewish by
Birth Mother Jewish at birth Maternal Grandmother Jewish at birth
I am a
Cohen Levi Israel
Cell Phone
Work Phone
Email
SECTION III | Personal Information
Address
City/State/Zip
Home Phone
Marital Status: Single Never been Married Married Divorced Widowed
Anniversary Date [DD / MM / YYYY]
Divorce Date
(if applicable) [DD / MM / YYYY]

If divorced, do you have a Jewish Get?
Yes No
Who was Get administered by?
Widowed Date (if applicable) [DD / MM / YYYY]
SECTION IV | Children
Child 1 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 2 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 3 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 4 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 5 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 6 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 7 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
Child 8 Male Female Name
Hebrew Name
Birth Date [DD / MM / YYYY]
/ /
Day Night School
  Are any children adopted?
Yes No
If yes, give details, including any conversion info:
SECTION V | Yahrtzeits
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]

Day
Night
Relationship
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]
Day
Night
Relationship
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]
Day
Night
Relationship
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]
Day
Night
Relationship
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]
Day
Night
Relationship
Name

[English / Hebrew / Father's Hebrew / Last]
Date of Passing [DD / MM / YYYY]
Day
Night
Relationship
Section VI | Membership Opportunities

Basic Membership

• Complimentary tickets to Annual Membership Melava Malka Gala
• Two High Holiday seats
• Listing of departed loved ones in Yizkor Booklet
• 25% discount on Hebrew School
• 20% discount on Bar/Bat Mitzvah fees (after 1st year of membership – must be enrolled in our Hebrew School)
• 5% discount on Gan Chamesh Preschool 2017
• 10% discount on most events and programs
• Menorah & Candles for Chanukah mailed to college age children at school
• Life Cycle event services
• Meals delivered for new babies and shiva
• Belonging to an amazing Jewish community & building lifelong friendships

The Annual Dues Scheule:

$1,440 Family Membership $120 Monthly Payment $770 Single Membership
TREE OF LIFE PARTNERSHIP CLUB – A MONTHLY DEDICATION OPPORTUNITY
Tree of Life partnership Club includes Membership Benefits and a leaf dedication plaque on the beautiful Tree of Life Wall
Chai - $180 Double Chai - $360 Triple Chai - $540
Chabad Connection - $770
Includes all of the above and 2 seats to Chabad’s Annual Dinner
   
Includes all of the above benefits plus a prominent Aliyah at High Holiday Services, admission with RSVP to any Chabad event gratis:
Builder - $1,300 Chai Minyan - $1,800 Hashem's Partner - $2,600
Silver Partner - $3,600 Gold Partner - $5,400 Diamond Partner - $7,200
Jubilee Chai Partner - $9,000    
Includes all of the above benefits and a complimentary table at Chabad’s Annual Dinner:
Visionary - $10,000 Community Pillar - $13,000 Chai Chazak- $18,000
Section VII | High Holiday Seat Reservations
Please indicate the names of all adults and children attending High Holiday Services on Rosh Hashana: October 2-4, and Yom Kippur: October 11-12.
Adult 1
Child 1
Two adult seats included with Family & Chai Partnership
Reserve Additional seats for:
Adult 2
Child 2
Additional Men's seats
[$120/seat]
Adult 3
Child 3
Additional Women's seats
[$120/seat]
Adult 4
Child 4
Additional Boy's seats
[$50/child]
Adult 5
Child 5
Additional Girl's seats
[$50/child]
Adult 6
Child 6
Total $ for seats
Section VIII | Payment Authorization

I would like to make a one time payment for everything pledged above. Please charge my card below.
I would like to make recurring monthly payments for membership (not including today's payment). Please charge my card below on the first of every month.

I would like to make recurring monthly payments for building fund (not including today’s payment). Please charge my card below on the first day of every month.
I would like to make recurring monthly payments for High Holiday Seats (not including today’s payment). Please charge my card below on the first day of every month.

Total Amount Pledged - Membership
$
Total Amount Pledged - High Holiday Seats
$
Total Amount Pledged - Tree of Life
$
Comments/Special Requests
Amount to be charged TODAY
[First recurring payment or one time amount]
$
Card Type
Card Number
Expiration Date
Card Security Code
I hereby certify that all information given above is true and correct and that I, and all members of my immediate family named herein, are Jewish by birth, or by conversion in accordance with Orthodox Jewish Law (Halacha).

 

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Updates
Join our family! Become a Member today.
Upcoming events
Feb. 21, 2017
with Rabbi Aharon Fehler
Feb. 21, 2017
with R' Eliezer Cohen
Feb. 21, 2017
Friendship Circle Winter Camp
Camp program for children with special needs. Three days of nonstop fun with daily trips, Jewish activities, Davening, fun and Space is limited so register ...
Feb. 21, 2017
Winter Camp for children in Grades k-3
Join for three fun filled days of fun! Exciting trips, creative Crafts, Baking. Register for all three days or just one. Trips & snacks are included ...
Click here to view our weekly Services Schedule