Partner (Check or Annual Lump Sum)

Your Info:
Full Name:*
First Name Last Name
E-mail:*
Cell Number*

Address:*

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

*

I am a member of Chabad (all my information is on file)I would like to become a member of Chabad
*

I 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
Partnership Opportunities
I would like to give:*

MonthlySingle Payment
Chai Club Please select a category

Supporter: $500 - $2,500/YrLeader: $2,500 - $5,400/YrPillar: $5,400 - $10,000/YrFounder: $10,000 - $30,000/YrLegacy: Over $30,000/Yr
Supporter:* Monthly Gifts up to $2,500/Yr

$208$166$83$62$41
Leader:* Monthly Gifts up to $5,400/Yr

$450$334$250$217
Pillar:* Monthly Gifts up to $10,000/Yr

$833$625$500$460
Founder:* Monthly Gifts up to $30,000/Yr

$2,500$2,083$1,667$875
Legacy:* Annual Gifts of $30,000+

Rabbi will be in contact with you. Thank you!
I would like my contribution to remain confidential and anonymous.
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

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