Shul Membership Form

Chabad of the West Sixties Shul Membership 5787 (2026-2027)
Thank You for Being Part of Our Chabad Family

Your membership helps us continue strengthening our community and providing meaningful Jewish experiences throughout the year.

Annual membership at Chabad follows the Jewish calendar and is renewed each year during August and September.

Membership Rates
- Family Membership â€“ $1,300
- Single Membership — $600
- Associate Membership — $360
  For those who are already members of another shul or who live outside the area and wish to support the work of Chabad.
Leadership Circle
- Visionary Partner — $18,000 ($1,500/month)
- Builder Partner — $10,000 ($833/month)
- Pillar Partner — $5,400 ($450/month)
- L'Chaim Partner — $3,600 ($300/month)
- Chai Partner — $1,800 ($150/month)
Please select:

I would like to renew my membership. All my information remains the same. (Fill in the REQUIRED* text fields on the form below and go to section 6 for payment)I would like to renew my membership. Please note the changes to my information below. (Fill in the REQUIRED* text fields and other updated fields on the form below and go to section 6 for payment)I would like to become a member (Fill in all sections as applicable and go to section 6 for payment)
SECTION I: YOUR INFO
Full Name*
First Name Last Name
Hebrew Name
E-mail*
Cell Number

Area Code Phone Number
Occupation
Work Number

Area Code Phone Number
Father's Hebrew Name
Mother's Hebrew Name
Birth Date

Month Day Year
Jewish by:

BirthConverted
Father is a:

KohenLeviIsrael
SECTION II: YOUR SPOUSE'S INFO
Full Name
First Name Last Name
Hebrew Name
E-mail
Cell Number

Area Code Phone Number
Occupation
Work Number

Area Code Phone Number
Father's Hebrew Name
Mother's Hebrew Name
Birth Date

Month Day Year
Jewish by:

BirthConverted
Father is a:

KohenLeviIsrael
SECTION III: PERSONAL INFORMATION

Address

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

Home Phone

Area Code Phone Number
Marital Status
Anniversary Date

Month Day Year
If divorced, do you have a Jewish "get"?

YesNo
SECTION IV: CHILDREN
Name
Birth Date

Month Day Year
Name
Birth Date

Month Day Year
Name
Birth Date

Month Day Year
Name
Birth Date

Month Day Year
SECTION V: YAHRZEIT INFORMATION
Name
Date of Passing

Month Day Year
Name
Date of Passing

Month Day Year
Name
Date of Passing

Month Day Year
SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS
Please select membership level:*

Family - $1300Single - $600Associate - $360Visionary Partner - $18,000 ($1,500 Monthly)Builder Partner — $10,000 ($833/month)Pillar Partner — $5,400 ($450/month)L'Chaim Partner — $3,600 ($300/month)Chai Partner — $1,800 ($150/month)
Payment Method:*

Please bill meCredit Card - Full PaymentCredit Card - 10 equal monthly payments
Total:

$0.00 USD

I would like to pay today:Full amount10% minimum: $0.00 USD$ USD

Card Details:

Credit Card Please bill me

Postal / Zip Code

Country

Checks can be mailed to: * New Address* Chabad of the West Sixties, 210 West 70th Street #509, New York, NY 10023.

Zelle can be sent to 9173340432

Venmo https://venmo.com/u/chabadw60s

PayPal https://paypal.com/us/fundraiser/charity/1409285

All contributions are tax deductible and can be paid throughout the year.
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Chabad of the West Sixties Shul Membership 5787 (2026-2027)

SECTION I: YOUR INFO

SECTION II: YOUR SPOUSE'S INFO

SECTION III: PERSONAL INFORMATION

SECTION IV: CHILDREN

SECTION V: YAHRZEIT INFORMATION

SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS