Membership 5783

Membership Application
If this is your first time confirming your membership at Chabad Lubavitch Torah Center, please complete this form, if you are renewing your membership for 5783, please complete our Renewal form.
PERSONAL INFORMATION
Family Name
Home Phone
Area CodePhone Number

Address

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

MARITAL STATUS
MarriedSingle (Never Married)WidowedDivorced
If Married, Date (m/dd/yy)
YOUR DETAILS
Your Name
Hebrew Name
CohenLeviYisroelConvert
Father's Hebrew Name
Mother's Hebrew Name
Birth Date
MonthDayYear
AMPM
Work Phone
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mail
I would like to receive news and updates by email
Occupation
SPOUSE DETAILS
First Name
Hebrew Name
CohenLeviYisroelConvert
Father's Hebrew Name
Mother's Hebrew Name
Birth Date
MonthDayYear
AMPM
Work Phone
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mail
Occupation
Children
Child 1
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 2
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 3
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 4
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 5
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 6
Hebrew Name
MaleFemale
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Birth Date
MonthDayYear
AMPM
Child 7
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Child 8
Hebrew Name
MaleFemale
Birth Date
MonthDayYear
AMPM
Yahrtzeits
Name 1 (English/Hebrew/Last)
Father's Hebrew Name
Relationship
Date & Time
AMPM
Name 2 (English/Hebrew/Last)
Father's Hebrew Name
Relationship
Date & Time
AMPM
Name 3 (English/Hebrew/Last)
Father's Hebrew Name
Relationship
Date & Time
AMPM
DUES SCHEDULE
CLTC's doors are always open to every Jew, yet some have asked how they can participate in a more formal manner. After consultation with participants, we are offering self-assessment sliding sclae guidelines for suggested dues. These funds will enable us to maintain our diversity and all-inclusive spirit while meeting the increasing shul costs and assuring the future of our growing congregation.
Please bear in mind, we will never turn any individual or family away who do not have the financial means. Your participation and growht is what matters, not how much you pay. As always, High Holiday seats are free to all.
Suggested Membership Dues*
$30,000 or less = $180$30,001 to $40,000 = $360$40,001 to $60,000 = $500$60,001 to $80,000 = $900$80,001 to $100,000 = $1,500$100,001 to $150,000 = $2,000$150,001 to $200,000 = $3,000> $200,000 = $4,000
Special Support Levels
Benefactor = $5,000Investor = $7,500Pillar = $10,000
*All membership fees can be made in one payment or in monthly installments
Total Paying Today
$180 USD$360 USD$500 USD$900 USD$1500 USD$2000 USD$3000 USD$4000 USD$5000 USD$7500 USD$10000 USD
Total
$0.00 USD
Yes, I'd like to make this a monthly recurring payment.
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Membership 5783

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