Membership

Chabad of Irvine Membership

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

Membership rates:

$1800 Chai Membership: $150 per month
$900 Senior/ Young Families Membership: $75 per month

Membership Benefits:

Free listings of departed loved ones in Yizkor booklet
2 Complimentary seats for High Holiday services
Discount on Preschool tuition
Discount on Hebrew School tuition
Discount on all Chabad events and programs including Shabbat Dinners, Passover Seders, JLI, and Lectures
Complimentary tickets to Annual Membership Event
A family member to receive honor during High Holidays Services
Facility charge waived for use of the Social Hall (Limit once annually, subject to availability and restrictions)
Belonging to amazing Jewish community & building lifelong friendships

Payment Options:

Choose to make your payment by check or credit card. You may also divide the dues into 12 separate post dated checks or credit card payments throughout the year. You may also choose to have us bill you periodically throughout the year.

We’d love for YOUR FAMILY to become a part of OUR FAMILY!

Full Name*

First NameLast Name

Occupation

E-mail*

Hebrew Name

Ben (Father’s Hebrew Name)

Ben (Mother’s Hebrew Name)

Birth Date

MonthDayYear

Jewish by?

BirthConverted

Select one

KohenLeviYisroel

Full Name*

First NameLast Name

Occupation

E-mail*

Hebrew Name

Bat (Father’s Hebrew Name)

Bat (Mother’s Hebrew Name)

Birth Date

MonthDayYear

Jewish by

BirthConvert

Select one

KohenLeviYisroel

Address

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

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Marital Status

SingleMarriedDivorcedWidowed

If divorced, do you have a Jewish "Get" ?

YesNo

Anniversary

MonthDayYear

Full Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Full Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Full Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Full Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Are any children adopted?

YesNo

If yes, give details, including any coversion info:

Name of Departed

Relationship

Hebrew Name

Ben (Father’s Hebrew Name)

Date of Passing

MonthDayYear

Time of Passing

Before NightfallAfter Nightfall

Please contact me regarding purchasing a plaque on the Chabad of Cobb’s Yartzeit board in memory of my loved one.

Name of Departed

Relationship

Hebrew Name

Ben (Father’s Hebrew Name)

Date of Passing

MonthDayYear

Time of Passing

Before NightfallAfter Nightfall

Please contact me regarding purchasing a plaque on the Chabad of Cobb’s Yartzeit board in memory of my loved one.

Name of Departed

Relationship

Hebrew Name

Ben (Father’s Hebrew Name)

Date of Passing

MonthDayYear

Time of Passing

Before NightfallAfter Nightfall

Please contact me regarding purchasing a plaque on the Chabad of Cobb’s Yartzeit board in memory of my loved one.

Membership Rate

Family: $1,800Single: $900

Payment Method*

Please bill meCheck, 12 post dated checksCredit Card, full paymentCredit card, 2 equal payments (one now, one in 6 months)Credit card, 12 equal payments (on first of each month)

Comments

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

*All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds. If you cannot afford the full amount requested, contact theRabbi for a confidential arrangement.

PERSONAL INFORMATION - HIS

PERSONAL INFORMATION – HERS

PERSONAL INFORMATION

CHILDREN

YARTZEIT INFORMATION

MEMBERSHIP CONTRIBUTIONS - ANNUAL