Shul Membership Form

Chabad of the West Sixties Shul Membership 5785/2024
We welcome you to join our membership family and enjoy being part of our wonderful community!

Annual membership at Chabad corresponds to the Jewish Year. Membership should be renewed every year during August/September.

Membership Rates:

$900 Family Membership
$540 Single Membership
$360 Associate Membership For those who are already members of other Shuls or fot those who do not live in the area and want to support the work of Chabad.

L'chaim Partner - $1,800 ($150 Monthly)

Silver Partner - $3,600 ($300 Monthly)

Platinum Partner - $18,000 ($1,500 Monthly)

If you cannot afford the full amount requested, please contact Rabbi Lipskier at [email protected] for a confidential arrangement.

We’d love for YOUR FAMILY to become a part of OUR FAMILY!
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 - $900Single - $540Associate - $360L'Chaim - $1,800 ($150 Monthly)Silver - $3,600 ($300 Monthly)Platinum - $18,000 ($1,500 Monthly)
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: Chabad of the West Sixties, 310 West 71st Street #2, New York, NY 10023. All contributions are tax deductible and can be paid throughout the year.
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Chabad of the West Sixties Shul Membership 5785/2024

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