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Membership Renewal

Membership Renewal

Chabad of Parkland Membership Renewal 5778 - 2017/18

(This form is for existing Members ONLY, new members please click here)

 

If any CHANGES have occurred during past year please make sure to update the relevant information, Thank you!

 

SECTION I: YOUR INFO

SECTION II: SPOUSE'S INFO

First Name

 

First Name

Last Name   Last Name
       
         

SECTION III: PERSONAL INFORMATION

Address   Email 1
City/State/Zip   Email 2
Home Phone   Marital Status
Work Phone   Anniversary Date / /
MM / DD / YYYY format

SECTION IV: CHILDREN

* please update if any changes have occurred over the past year

Name

 

Birth Date

/ /
MM / DD / YYYY format

Name

 

Birth Date

/ /
MM / DD / YYYY format

Name

 

Birth Date

/ /
MM / DD / YYYY format
         

SECTION V: YAHRZEIT INFORMATION

 

* please update if any changes have occurred over the past year

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
  / /
Date of Passing: MM / DD / YYYY
Relationship





 

SECTION VI: MEMBERSHIP CONTRIBUTIONS - ANNUAL


Benefactor: $1800

Family: $700

Senior Couples: $360

Single or Single Parent Family: $360

Single Senior: $250

 

All members receive 2 seats for High Holiday services (Benefactors receive 4)

If you wish to reserve additional seats please add names below at $60 per seat.

Additional seat names (Separate each name with a comma):

Charge options:

One full payment of:

Please charge:

Visa M/C AMEX
  Quarterly payments, each Card #:
  Monthly payments of each Exp. Date
 

Payment Method:

Credit Card
Check
Optional Comments:


SECTION VII: CHOICE OF LOCATION

Rosh Hashana Services: (Sep 20-22)

Yom Kippur Services:(Sep 29-30)

 Marriott Hotel Service

 Loxahatchee Rd. Service

 Main Combined Service

 Sephardic Service

  High Holiday Seating Requests: 

All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds.

For any questions, or if you cannot afford the full amount requested, contact a Rabbi for a confidential arrangement on 954.970.9551.

 

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