Membership Form - ChabadAZ.com

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Membership Type

Returning MemberNew Member

Husband's Info

First Name Last Name

Husband Cell Number

Area Code Phone Number

Husband E-mail

Husband Birth Date

Month Day Year

Wife Name

First Name Last Name

Wife Cell Number

Area Code Phone Number

Wife E-mail

Wife Birth Date

Month Day Year

Home Address

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

Home Phone Number

Area Code Phone Number

Children: Names and Birthdays

General Membership $1,800 - $150 each month

Includes…

· Reserved seats for High Holiday services (Immediate Household Members)

· Classes and individual consultation with the Rabbi

· Rabbi’s service and use of Shul for lifecycle events

· Unlimited use of the Shul’s book library

· Reduced fees for Shul rental and special programs

· Inclusion in all social and educational activities, including Sisterhood, Men’s Club, and youth groups

· Great rewards in this world and in the Next!!

Memberships may be paid in equal monthly installments

Upgraded Packages:

Silver Membership ($2,400/year)

General + reserve 2 High Holiday seats for parents or friends if paid in full by September 1^st.

Gold Membership (3600/year)

Silver + receive a gift of Torah books if paid in full by September 1^st.

Platinum Membership ($5400/year)

Gold + free attendance to all Shabbatons if paid in full by September 1.

Diamond Membership ($7200/year)

Platinum + 2 free tickets to the Annual Dinner.

Membership Level

Just High Holiday Seats - Must be paid in Advance

Based on your above choices, please list:

Men's Side Seats and Names of Attendees
Women's Side Seats and Names of Attendees

Members may reserve seats for household - immediate family members.

Seats:

I would like to Sponsor for the Shul

Shabbos Morning Kids Program $100Shabbos Morning Kiddush Club (for a no sponsor week) $100A Week of Security Guard $160

High Holiday Aliyah

I would like an Aliyah during the High Holidays - Please Call Me

Please prepay my Tax Credit Now!

Chabad Tuition Org Tuition Tax Credit Joint Filing $2,609.00Chabad Tuition Org Tuition Tax Credit Single Filing $1,307.00Ten Yad Helping Hand Charitable Tax Credit Joint Filing $800.00Ten Yad Helping Hand Charitable Tax Credit Single Filing $400.00

Please Charge My Card Now - If $0 is selected, the office will reach out to you.

$0

Yes, I'd like to make this a monthly recurring payment.

Notes for the Office

Payment

Credit Card Mail in Check/s

Membership Form 5785 | 2024/5