Chai Club Membership

Your Info:
Full Name:*
First Name Last Name
*

KohainLeviYisrael
E-mail:*
Cell Number*

Address:*

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

*

I am a proud member of Chabad of Greater Orlando - All my info is on fileI am a new Chabad Member - I will complete this formI would like to meet with the RabbiI would like to be contacted about volunteer opportunities
Marital Status*

MarriedDivorcedSingleWidow(er)
Anniversary*

Month Day Year
Household Information
How many household members* Please include kids in college
Full Name 1
First Name Last Name
Hebrew Name 1
First Name Last Name
Fathers Hebrew name 1
First Name Last Name
Mothers Hebrew Name 1
First Name Last Name
Birth Date

Month Day Year
E-mail 1
Cell Phone Number 1
Full Name 2
First Name Last Name
Hebrew Name 2
First Name Last Name
Fathers Hebrew Name 2
First Name Last Name
Mothers Hebrew Name 2
First Name Last Name
Birth Date

Month Day Year
E-mail 2
Cell Phone Number 2
Full Name 3
First Name Last Name
Hebrew Name 3
First Name Last Name
Fathers Hebrew Name 3
First Name Last Name
Mothers Hebrew Name 3
First Name Last Name
Birth Date

Month Day Year
E-mail 3
Cell Phone Number 3
Full Name 4
First Name Last Name
Hebrew Name 4
First Name Last Name
Fathers Hebrew Name 4
First Name Last Name
Mothers Hebrew Name 4
First Name Last Name
Birth Date

Month Day Year
E-mail 4
Cell Phone Number 4
Full Name 5
First Name Last Name
Hebrew Name 5
First Name Last Name
Fathers Hebrew Name 5
First Name Last Name
Mothers Hebrew Name 5
First Name Last Name
Birth Date

Month Day Year
E-mail 5
Cell Phone Number 5
Full Name 6
First Name Last Name
Hebrew Name 6
First Name Last Name
Fathers Hebrew Name 6
First Name Last Name
Mothers Hebrew Name 6
First Name Last Name
Birth Date

Month Day Year
Cell Phone Number 6
E-mail 6
Full Name 7
First Name Last Name
Hebrew Name 7
First Name Last Name
Fathers Hebrew Name 7
First Name Last Name
Mothers Hebrew Name 7
First Name Last Name
Birth Date

Month Day Year
E-mail 7
Cell Number 7
Yahrtzeit Information
How many Yahrtzeit observances do you have?
Name of Deceased 1
First Name Last Name
Fathers Hebrew Name
First Name Last Name
Date of Death

Month Day Year
Before SunsetAfter SunsetUnknown
Relationship
Name of Deceased 2
First Name Last Name
Fathers Hebrew Name
First Name Last Name
Date of Death

Month Day Year
Before SunsetAfter SunsetUnknown
Relationship
Name of Deceased 3
First Name Last Name
Fathers Hebrew Name
First Name Last Name
Date of Death

Month Day Year
Before SunsetAfter SunsetUnknown
Relationship
Name of Deceased 4
First Name Last Name
Fathers Hebrew Name
First Name Last Name
Date of Death

Month Day Year
Before SunsetAfter SunsetUnknown
Relationship
Membership Fees
I would like to give:*

MonthlySingle Payment
Annual Membership

Individual Membership - $1200Family Membership - $1800
Monthly Membership

Individual Membership - $100 per monthFamily Membership - $150 per month
Sponsorship Opportunities
Sponsorship opportunities are on top of your membership fees.
Please consider supporting Chabad of Greater Orlando and all the programs we provide.
Chai Club Please select a category

Chai Club Supporter - Up to $2,500Chai Pillars Club - Up to $10,000Chai Leaders Club - Up to $25,000Chai Founders Club - Up to $100,000Chai Legacy Club - Over $100,000
Chai Club Supporter:* Annual Gifts up to $2,500

$2,500$1,800$1,000$540$360Please contact me to set up a payment plan
Chai Pillars Club:* Annual Gifts up to $10,000

$9,999$7,500$5,000$2,500Please contact me to set up a payment plan
Chai Leaders Club:* Annual Gifts up to $25,000

$24,000$18,000$12,000$10,000Please contact me to set up a payment plan
Chai Founders Club* Annual Gifts up to $100,000

$99,000$72,000$50,000$36,000$25,000Please contact me to set up a payment plan
Chai Legacy Club* Annual Gifts of $100,000+

$1,000,000$500,000$250,000$100,000Please contact me to set up a payment plan
PLEASE KEEP THIS CONTRIBUTION CONFIDENTIAL
I would like to be contacted to set up an endowment, will, bequest, or living trust
I hereby declare that:*

All information in this membership form is true to the best of my knowledgeI must disclose to the Rabbi if I, or any family member have undergone conversion or adoption
Payment
Total:

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%
How would you like to pay?*

Pay now with a credit cardI will send a checkContact me to create a payment plan
Checks are payable to Chabad CAY
Mailing Address - 708 Lake Howell Rd Maitland FL
Please call us with any questions 407 644 2500
Someone from the Chabad Cay office will contact you with number or email you provided to set up a payment plan.
Please call us with any questions 407 644 2500

Payment:

Credit Card

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Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Chai Club Membership

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