Synagogue Membership

Chabad of Rockland Synagogue Membership
We welcome you to join our membership family and enjoy being part of our wonderful community!

Annual membership at Chabad corresponds to the Jewish Year. Membership should be renewed every year during August.

Membership Rates:

$1,100 Family Membership
$750 Single Parent Membership
$750 Senior Citizen Membership
$500 Single Person Membership

Membership Benefits:

• 2 Complimentary seats for High Holiday services / 1 Complimentary seat for single membership
• Free membership in Junior Congregation.
• Belonging to an amazing Jewish community & building lifelong friendships

We’d love for YOUR FAMILY to become a part of OUR FAMILY!
Please select one:

I would like to renew my membership. All my information remains the same. (Fill in the REQUIRED* text fields on the form below and go to section 6 for payment)I would like to renew my membership. Please note the changes to my information below. (Fill in the REQUIRED* text fields and other updated fields on the form below and go to section 6 for payment)I would like to become a member (Fill in all sections as applicable and go to section 6 for payment)
SECTION I: YOUR INFO
Full Name

First Name Last Name
Hebrew Name
E-mail
Cell Number

Area Code Phone Number
Occupation
Work Number

Area Code Phone Number
Father's Hebrew Name
Mother's Hebrew Name
Birth Date

Month Day Year
Jewish by:

BirthConverted
Father is a:

KohenLeviIsrael
SECTION II: YOUR SPOUSE'S INFO
Spouse Full Name

First Name Last Name
I would like to receive news and updates by email
Spouse Hebrew Name
E-mail
Cell Number

Area Code Phone Number
Occupation
Work Number

Area Code Phone Number
Father's Hebrew Name
Mother's Hebrew Name
Birth Date

Month Day Year
Father is a:

KohenLeviIsrael
Jewish by:

BirthConverted
SECTION III: PERSONAL INFORMATION

Address

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

Home Phone

Area Code Phone Number
Marital Status
Anniversary Date

Month Day Year
If Divorced, do you have a Jewish "get" (divorce document)

YesNo
SECTION IV: CHILDREN
Please list children's names and dates of birth
SECTION V: YAHRTZEIT INFORMATION
Name
Date of Passing

Month Day Year
Relationship
Name
Date of Passing

Month Day Year
Relationship
Name
Date of Passing

Month Day Year
Relationship
Name
Date of Passing

Month Day Year
Relationship
Additional names / Relationships / Dates of Passing
SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS
Select your plan

Family - $1,100Family Partial Payment - $550Single Parent - $750Single Parent Partial Payment - $375Senior Citizen - $750 (over 65 with no children at home)Senior Citizen Partial Payment - $375Single Person - $500Single Person Partial Payment - $250
Additional Donation

$18$36$54$72$90$108
Total

$0.00

Payment

Credit Card eCheck Check

Postal / Zip Code

Country

Should be Empty:

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Mi Shebeirach List

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Synagogue Membership
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Chabad of Rockland Synagogue Membership

SECTION I: YOUR INFO

SECTION II: YOUR SPOUSE'S INFO

SECTION III: PERSONAL INFORMATION

SECTION IV: CHILDREN

SECTION V: YAHRTZEIT INFORMATION

SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS