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Membership

Membership

Chabad of Dallas - Membership Form

July 1st 2017 - June 30 2018

We invite you to join our growing family and become part of this wonderful community.

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 2017-18 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 this past year is a reflection of the dedication and support of our members. The Shul is truly dependent upon the financial resources provided through the support of a committed membership base.

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
Jewish by: Birth Converted   Jewish by:

Birth Converted   *Conversion Documentation Required

Check One:

Cohen Levi Israel

Bar Mitzvah Parsha 

  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

Name/Hebrew Name

 

Birth Date

/ /
MM / DD / YYYY format

School Grade     Time of Day: (approx)

Name/Hebrew Name

 

Birth Date

/ /
MM / DD / YYYY format
School Grade     Time of Day: (approx)

Name/Hebrew Name

 

Birth Date

/ /
MM / DD / YYYY format
School Grade     Time of Day: (approx)
Are any children adopted? Yes No - If yes, give details, including any conversion info:

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

I am interested in participating in the following areas

Synagogue services Holiday Programming Fundraising Committee
Junior Congregation Youth Programming Kiddush Club
Adult Education Teen Programming Special Events
Sisterhood Hospitality Kiddush Prep and Setup
Hebrew School Mikvah Chesed Opportunities

SECTION VI: MEMBERSHIP CONTRIBUTIONS

Membership*****

Annual

Monthly

Chai Club Sponsor*    $5,000 $417
Chai Club Benefactor**             $2,500 $209
Family (ages 35+)*** $1,800 $150
Young/Senior Family (under 35/67+)*** $1,000 $84

Single or Single*** Parent

$750 $62.50
Associate**** $600 $50

* Chai Club Sponsor Membership will include the following benefits:  6 High Holiday seats, Kiddush Club membership, free admission for 4 to all Shul sponsored dinner events throughout the year, member level acknowledgement in the Shul’s weekly bulletin, and 10% off shul sponsored classes.

** Chai Club Benefactor Membership will include the following benefits:  4 High Holiday seats, 1 table of 10 for a Shul sponsored dinner, kiddush club, member level acknowledgement in the Shul’s weekly bulletin, and 10% off shul sponsored classes.

*** Family, Young/Senior Family & Single Membership will include the following benefits: 2 High Holiday seats, 10% off shul sponsored classes

**** Important: Associate membership available only to family/individual currently holding full membership at another synagogue.

*****All membership levels are entitled to discounted pricing to all family simchas held at the Shul

 Primary Synagogue Affiliation (for Associate Membership Level): 

Annual Membership Commitment $

     
Please charge my:

Visa M/C

AMEX

Card #:
Email  
 I would like the total amount listed above to be charged per the following payment schedule:   full payment   monthly payment

 

 
SECTION VII: REQUESTS FOR FINANCIAL ASSISTANCE

Chabad of Dallas desires to accept all those wishing to be members and participate in our programs regardless of financial means.  Those wishing to receive financial assistance should contact our office and request the confidential Dues Reduction request form, which should be completed and returned in order to process your request. 

It is the intention of Chabad of Dallas that no person or family will be turned away due to lack of financial means.


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

 

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