Membership Application

Prefer to print and mail in this application? Please CLICK HERE for a downloadable PDF.
Membership at Sha'arei Israel and Chabad Center of Jewish Life means that you partner with us in bringing authentic Jewish values to our area. The money we raise via membership helps cover the many programs that we offer, including our synagogue services and programs, adult and youth educational opportunities, Jewish Women Circle events, Camp Gan Israel, senior meals and programming, CTeen chapter, and much more. Every penny contributed stays right here, working in our community, benefiting everyone. Literally thousands of lives were touched in a positive way through our activities this past year. But there is so much more to do.
Sha'arei Israel is a registered 501(c)(3) nonprofit organization. All charitable contributions are tax-deductible. You will receive a tax receipt by email or direct mail unless otherwise noted below.
We welcome you to join our membership family and enjoy being part of our wonderful community!
Personal Information
Family Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Your Details
Your First Name*
Hebrew Name
Please Choose One
CohenLeviYisroelConvert
Birth Date*
MonthDayYear
Time of Birth*
DayEvening/Night
Father's Hebrew Name
Mother's Hebrew Name
Work Number
Area CodePhone Number
Cell Phone Number*
Area CodePhone Number
E-mail*
Employer
Spouse's Details (if applicable)
Hebrew Name
Please Choose One
CohenLeviYisroelConvert
Birth Date
MonthDayYear
Time of Birth
DayEvening/Night
Father's Hebrew Name
Mother's Hebrew Name
Work Phone
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mail
Employer
Marital Status
Never Been Married (skip to the next section)Married (please list your anniversary below)Divorced (please list the date below)Widowed (please list the date below)
Date(s) / Details
If you have a "get" please list who administered it
Children
Child 1 Name
First NameLast Name
Child 1 Hebrew Name
Child 1 Birth Date
MonthDayYear
Child 1 Gender
MaleFemale
Child 1 School
Child 2 Name
First NameLast Name
Child 2 Hebrew Name
Child 2 Birth Date
MonthDayYear
Child 2 Gender
MaleFemale
Child 2 School
Please list the same information for any additional children
Additional Information
Have there been any conversions in the family?(parents, grandparents, great-grandparents, etc.)
NoYes (Please complete details below)
Conversion Administered By
City/State, and Year
Please list Yartzeits of Parent(s) and/or Child(ren)
Yartzeit 1 Name
First NameHebrew NameLast Name
Yartzeit 1 Father's Hebrew Name
Yartzeit 1 Relationship
Yartzeit 1 Date/Time of Passing
MonthDayYear
at HourMinutes
Yartzeit 2 Name
First NameHebrew NameLast Name
Yartzeit 2 Father's Hebrew Name
Yartzeit 2 Relationship
Yartzeit 2 Date/Time of Passing
MonthDayYear
at HourMinutes
Please list the same information for any additional yartzeits
Membership Information
Nobody will be turned away due to lack of funds.
Dues*Please select the option that best applies.
35+ Individual - $80035+ Family - $160070+ (Senior Dues) Individual - $80070+ (Senior Dues) Family - $110033-34 Individual - $65033-34 Family - $130030-32 Individual - $52530-32 Family - $950Under 30 Individual - $200Under 30 Family - $350Sunday/Hebrew School (first year) - $540Sunday/Hebrew School (year 2) - $720Sunday/Hebrew School (year 3) - $900
Building Fund*
$300 Annually (for a maximum of 10 years)$25 MonthlyContact me to discuss
Please select the committee(s) that you would like to participate in*If no committee is selected then one will be chosen for you.
EducationFinanceFund raisingFacilities maintenanceMembershipPublicityRitualSocialPlease include me where I'm most needed
ClubsClub participation is entirely voluntary.
Mens's ClubSisterhood
Additional Information
Please provide any information that the Rabbi may need to know. All information is kept confidential.
Payment Information
Total
$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Personal Information

Your Details

Spouse's Details (if applicable)

Marital Status

Children

Additional Information

Membership Information

Payment Information