Printed from ChabadPlano.org

Current Members Yearly Update Form

Current Members Yearly Update Form

ABRIDGED FORM FOR CURRENT MEMBERS ONLY.
Signing up as a member for the first time? Click here for the full form.

Please keep us updated on these important changes in your life.
Please notify us below of any new births (or other family Simchas) or deaths.
This will enable us to keep our records current and notify you of upcoming
Yahrtzeits and have them listed in the Shul’s weekly announcements.
SECTION I: ADULT MALE

SECTION II: ADULT FEMALE

Name, First Last

Name, First Last

SECTION II: FAMILY UPDATE - since September 2016
NEW CONTACT INFO
New Address New Home Phone
New Email (male) New Cell (male)
New Email (female) New Cell (female)
CHILDREN - born since September 1 2016

English/Hebrew Name Date of Birth / /
MM / DD / YYYY format
Before / After Sundown
English/Hebrew Name Date of Birth / /
MM / DD / YYYY format
Before / After Sundown
YARTZEITS - of loved ones who have passed away since September 1, 2016
English Name
Hebrew Name
Relation Date of Yartzeit / Time of Day

/ /
MM / DD / YYYY format

/ /
MM / DD / YYYY format

High Holiday Attendance Form 5777-2016
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 sevices.
Click here for a detailed schedule of children's programs.
Looking forward to seeing you on the High Holidays!

SECTION III: 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
Volunteer Opportunities
I will be happy to volunteer for the following:
Helping to prepare for a Kiddush or Simcha
Helping us cook or visit those in need (i.e. birth of a child, an illness, loss in the family)
Fixing and maintaining our building
Setting up the Shul for Shabbos and Holidays
General volunteering
Call me to discuss

SECTION IV: 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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