Membership Form

The membership year goes from September until August.
The membership fee will be charged on September 1.

Full Name*

First Name Last Name

Hebrew Name

Fathers Hebrew Name

Mothers Hebrew Name

Occupation

E-mail*

Cell Phone Number*

Birth Date*

Month Day Year

I have a spouseI have childrenI would like to add my loved one(s) Yartzeit(s).

Full Name

First Name Last Name

Hebrew Name

Fathers Hebrew Name

Mothers Hebrew Name

Occupation

E-mail

Cell Phone Number

Birth Date

Month Day Year

Address*

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

Home Phone Number

Work Phone Number

Marital Status

SingleMarriedDivorcedWidowed

Anniversary Date

Month Day Year

1. Name

1. Birth Date

Month Day Year

2. Name

2. Birth Date

Month Day Year

3. Name

3. Birth Date

Month Day Year

4. Name

4. Birth Date

Month Day Year

5. Name

5. Birth Date

Month Day Year

Name and Address of my children/grandchildren in college:

1. Full Name

First Name Last Name

1. Hebrew Name

1. Fathers Hebrew Name

1. Date of passing

Month Day Year

2. Full Name

First Name Last Name

2. Hebrew Name

2. Fathers Hebrew Name

2. Date of passing

Month Day Year

3. Full Name

First Name Last Name

3. Hebrew Name

3. Fathers Hebrew Name

3. Date of passing

Month Day Year

4. Full Name

First Name Last Name

4. Hebrew Name

4. Fathers Hebrew Name

4. Date of passing

Month Day Year

Please select:

$1,800 Family Membership (Or $150/monthly)$3,000 Upgraded Membership (Or $250/monthly)$1,500 Single Parent Family (OR $125/monthly)$900 Single Membership (OR $75/monthly)$1500 Senior Citizen Membership (Or $125/monthly)

Please select:

$1,800 Family Membership (Or $150/monthly)$3,000 Upgraded Membership (Or $250/monthly)$1,500 Single Parent Family (OR $125/monthly)$900 Single Membership (OR $75/monthly)

The CHAI SOCIETY Members are the pillars of our community. It is because of you that we can continue to offer the highest level of educational, religious and social programming, and making this all available to all, regardless of their ability to pay.

Please select:

Chai Donor: $5,000 (OR $416/monthly)Chai Partner: $10,000 (OR $833/monthly)Chai Rabbi's Circle: $18,000 (OR $1,500/monthly)Chai Leadership Circle: $36,000 (OR $3,000/monthly)

Please select:

Chai Donor: $5,000 (OR $416/monthly)Chai Partner: $10,000 (OR $833/monthly)Chai Rabbi's Circle: $18,000 (OR $1,500/monthly)Chai Leadership Circle: $36,000 (OR $3,000/monthly)

Rabbi Arik will be happy to meet with you to share a presentation, so you can see the impact of your support. He can be reached at [email protected]

Payment Options*

Full Payment2 Equal Payments (one now, one on Dec 26)12 Monthly Payments10 Monthly Payments

Payment*

Credit Card (Preferred:) Check, Zelle, Venmo

Postal / Zip Code

Country

Notes

Spouse 1

Spouse 2

Family Information

Children

Yahrtzeit Information

General Membership

Chai Society Membership

Synagogue Services

Hebrew School

Teens

Adult Education

Holidays

Gan Montessori