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

Cohen Levi Yisroel Convert
Birth Date*

Month Day Year
Time of Birth*

Day Evening/Night
Father's Hebrew Name
Mother's Hebrew Name
Work Number

Area Code Phone Number
Cell Phone Number*

Area Code Phone Number
E-mail*
Employer
Spouse's Details (if applicable)
Hebrew Name
Please Choose One

Cohen Levi Yisroel Convert
Birth Date

Month Day Year
Time of Birth

Day Evening/Night
Father's Hebrew Name
Mother's Hebrew Name
Work Phone

Area Code Phone Number
Cell Phone

Area Code Phone 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 Name Last Name
Child 1 Hebrew Name
Child 1 Birth Date

Month Day Year
Child 1 Gender

Male Female
Child 1 School
Child 2 Name

First Name Last Name
Child 2 Hebrew Name
Child 2 Birth Date

Month Day Year
Child 2 Gender

Male Female
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.)

No Yes (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 Name Hebrew Name Last Name
Yartzeit 1 Father's Hebrew Name
Yartzeit 1 Relationship
Yartzeit 1 Date/Time of Passing

Month Day Year
at Hour Minutes
Yartzeit 2 Name

First Name Hebrew Name Last Name
Yartzeit 2 Father's Hebrew Name
Yartzeit 2 Relationship
Yartzeit 2 Date/Time of Passing

Month Day Year
at Hour Minutes
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 - $800 35+ Family - $1600 70+ (Senior Dues) Individual - $800 70+ (Senior Dues) Family - $1100 33-34 Individual - $650 33-34 Family - $1300 30-32 Individual - $525 30-32 Family - $950 Under 30 Individual - $200 Under 30 Family - $350 Sunday/Hebrew School (first year) - $540 Sunday/Hebrew School (year 2) - $720 Sunday/Hebrew School (year 3) - $900
Building Fund*

$300 Annually (for a maximum of 10 years) $25 Monthly Contact 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.

Education Finance Fund raising Facilities maintenance Membership Publicity Ritual Social Please include me where I'm most needed
Clubs Club participation is entirely voluntary.

Mens's Club Sisterhood
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 Paypal Check or Cash

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