Printed from ChabadPlano.org

New Members Membership Form

New Members Membership Form

NEW MEMBERS FORM
Current members click here for the abridged update-only form


September 1, 2016 - August 31, 2017

We invite you to join our growing family and become part of this wonderful community. High Holiday seats are included with membership.

We are a diverse group of people from various levels of observance who come together for learning, spiritual growth, social interaction and friendship.

As we head into the 2016-2017 membership year, we reflect on the Shul’s accomplishments of the past year and look forward to the future with excitement as it is filled with new opportunities for our continued growth. The success we have achieved since the opening of our building is a reflection of the dedication and support of our members. The Chabad Center is truly dependent upon the financial resources provided through the support of a committed membership base.

With the High Holidays approaching, please take a moment to submit the form below. Upon receipt, we will email you a confirmation letter for your High Holiday seats. We look forward to your support as a member of Chabad.

If you would like more information, please do not hesitate to call Chabad at (972) 596-8270. For questions regarding finances, please call our Financial Chair Stan Rothstein at (972) 931-0150.

SECTION I: ADULT MALE

SECTION II: ADULT FEMALE

Name

Name

Hebrew Name Hebrew Name
Father's
Hebrew Name
Father's Hebrew Name
Mother's
Hebrew Name
Mother's
Hebrew Name
Occupation Occupation
Birth Date / /
MM / DD / YYYY format
Birth Date / /
MM / DD / YYYY format
Business Phone Business Phone
Cell Phone Cell Phone
Email Email
Was birth mother Jewish? yes no
If not, did you convert? yes no
Was birth mother Jewish? yes no
If not, did you convert? yes no
Check One: Cohen Levi Israel Check One: Cohen Levi Israel

SECTION III: PERSONAL INFORMATION

Address Marital Status
City/State/Zip Anniversary Date / /
MM / DD / YYYY format
Home Phone If Divorced: If divorced, do you have a
Jewish "Get" ? Yes No

SECTION IV: CHILDREN

English/Hebrew Name

Birth Date

/ /
MM / DD / YYYY format

School Grade Before / After Sundown

English/Hebrew Name

Birth Date

/ /
MM / DD / YYYY format
School Grade Before / After Sundown

English/Hebrew Name

Birth Date

/ /
MM / DD / YYYY format
School Grade Before / After Sundown
If any children were not born Jewish please include a copy of certificate of conversion, if applicable.

SECTION V: YAHRZEIT INFORMATION

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

Name


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

High Holiday Attendance Form 5776-2015
All memberships include High Holiday seats. Family memberships include all minor children up to the age of 18, or children who have full-time student status.

ADULTS (enter names) CHILDREN (enter names & ages) GUESTS (enter names, list ages for kids) Guest Rates
age age Out of Town relatives of Members: $75 per person
age age Local relatives of Members: $125/person
age age Non-Members: $150/person
age age Children: $36

Click here for a detailed schedule of all the holiday services.
Click here for a detailed schedule of children's programs.
Looking forward to seeing you on the High Holidays!

I am interested in participating in the following areas

Synagogue services Holiday Celebrations Leading the Service
Junior Congregation Youth Club Activities Reading from the Torah
Adult Education Teen Activities General Volunteering
Women's Circle The Frisco Gan Cooking for Celebrations and Kiddushim
Sunday Hebrew School Camp Gan Israel

SECTION VI: MEMBERSHIP CONTRIBUTIONS

Membership

Annual

Bi-Annual
(9/1, 3/1)

Quarterly
(9/1, 12/1, 3/ 1, 6/1)
Monthly
Chai Benefactor
$5,000 $2,500 $1,250 $416.66
Chai Patron
$3,600 $1,800 $900 $300.00
Chai Friend
$2,500 $1,250 $625 $208.33
Family
(Ages 35-65)
$1,800 $900 $450 $150.00
Young/Senior Family
(Ages: 30-34 OR 66+)
$1,300 $650 $325 $108.33
Single or Single Parent $1,100 $550 $275 $91.66
Young Family
(Both under 30)
$500 $250 $125 $41.67
Age groups are determined by the oldest household member as of 9/1/16.

Chai Level Memberships

Chai Benefactor Level:
A personalized Torah book and 1 Kiddush Sponsorship
Chai Patron Level:
A personalized Torah book and 1 Tefillin Club Sponsorship
Chai Friend Level:
A personalized Torah book and 1 Sunday Bagels & Lox Sponsorship
Additional Support:
I cannot be a Chai Member donor, but I would like to make a contribution of $ above and beyond
my membership to help expand our programs and help those in need of scholarships.

I would like to contribute the above total amount per the payment schedule below:
Full Payment Bi-Annual Quarterly Monthly | Use credit/debit card below By Check

SECTION VI: PAYMENT OPTIONS

• Payment in full by cash, check or credit card
• Bi-Annual & Quarterly payments using a credit card only. Your credit card will be charged on the first business day of your selected payment schedule
Paying By: Check Full Payment
Donor Advised Fund Full Payment
Credit Card/ Debit Card Full Payment Bi-Annual Quarterly Monthly
Cardholder First Name: Last Name:
Please charge my: Visa M/C AMEX Exp. Date
Card #: CVV

SECTION VII: REQUESTS FOR FINANCIAL ASSISTANCE

Chabad of Plano wishes to accept all who want to be members and participate in its programs regardless of financial means. Our financial chair will contact you and a mutually agreed upon fee will be arranged. This will occur in a strictly confidential manner. No person or family will be turned away due to lack of financial means. Please use the following area to state reason for financial assistance request:

please contact me on my: home phone cell phone (as shown above)

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