Printed from ChabadIrvine.org

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:
- 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
- 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!
PERSONAL INFORMATION - HIS
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
PERSONAL INFORMATION – HERS
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
PERSONAL INFORMATION

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
CHILDREN
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:
YARTZEIT INFORMATION
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 Irvine’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 Irvine’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 Irvine’s Yartzeit board in memory of my loved one.
MEMBERSHIP CONTRIBUTIONS - ANNUAL
Family: $1,800 ~ Single/ Young Family/ Senior: $900
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.
Should be Empty:

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PERSONAL INFORMATION - HIS

PERSONAL INFORMATION – HERS

PERSONAL INFORMATION

CHILDREN

YARTZEIT INFORMATION

MEMBERSHIP CONTRIBUTIONS - ANNUAL