Printed from ChabadDaytona.org

Membership Application

Membership Application

Membership

Chabad Lubavitch of Greater Daytona
1079 W Granada Blvd
Ormond Beach, FL 32174
Tel 386.672.9300 Fax 386.672.9303
 

Membership Application 
 

Family Name:           
Title:                       Mr. Mrs.  Ms.  Dr.  Rabbi

Husband:                     
Date of Birth:            
Hebrew name:           

Wife:                        
Date of Birth:           
Hebrew Name:          

Home Address:          
City/State/Zip:         
Home Phone:            

Children:  (Name, Hebrew Name, Date of Birth)  
                                   


Yartzeits:  (Name and Relation, English Date of Yahrzeit, day or night)   
                                   

Aliya Infromation:
Parents Hebrew Name

(Father):              
(Mother):             

Spouse's Hebrew Name

(Father):              
(Mother):            
Kohain
Levite
Israelite
Bar Mitzvah Portion

Please check your membership level:
 Family - $700 
 Single/Seasonal/Associate - $450
 Senior Couple - $600
 Senior Single - $350  

I wish to make these payments:
Annually:  1 payment due 9/1
Semi-Annually: 2 payment due 9/1/ & 12/1
Quarterly: 4 payments due 9/1,12/1, 3/1 & 5/1


Building Fund Donation:   

 $36
 $90  
 $180  
 $250  
 $360  
 $540  
 $1000  
 $1800
 Other $


Membership:                        
Building Fund Donation:     
Total:                          $

Payment:
 Check (mail or deliver to address above)
 Credit Card - contact office at phone # above or  click here now and pay by credit card.


Should you have any financial difficulty paying the above fees, please contact the office at the number above.


 

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